Defining ascending aorta dilatation in pediatric bicuspid aortic valve: Comparison of known classical and new z-score nomograms, and anthropometric parameters indexing for its assessment

Freixa-Benavente, A; Juzga-Corrales, C; Ayerza-Casas, A; Figueras-Coll, M; Escribà-Bori, S; Plata-Izquierdo, B; Collell, R; González-Marín, MA; Siurana, JM; Sorlí-García, M; de la Torre, L; Teodoro-Marín, S; Rodriguez, M; Domínguez-García, O; Rellán, S; Manso, B; López-Abel, B; Alvarez-Pérez, R; Portillo-Márquez, M; Rezola-Arcelus, E; Centeno-Malfaz, F; Solana-Gracia, R; Rojo-Sombrero, H; Cantero-Tejedor, MT; Riaño, B; Tejero-Hernández, MA; Jiménez-Casso, M; Sabaté-Rotés, A

Defining ascending aorta dilatation in pediatric bicuspid aortic valve: Comparison of known classical and new z-score nomograms, and anthropometric parameters indexing for its assessment

Background: Ascending aorta (AscAo) dilatation assessment and definition in pediatric bicuspid aortic valve (BAV) is challenging. We compared the Pediatric Heart Network (PHN) nomogram against the Halifax (HZ) one and analyzed their association with body surface area indexing (BSAI). Methods: Echoca...

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Autores:	Freixa-Benavente, A, Juzga-Corrales, C, Ayerza-Casas, A, Figueras-Coll, M, Escribà-Bori, S, Plata-Izquierdo, B, Collell, R, González-Marín, MA, Siurana, JM, Sorlí-García, M, de la Torre, L, Teodoro-Marín, S, Rodriguez, M, Domínguez-García, O, Rellán, S, Manso, B, López-Abel, B, Alvarez-Pérez, R, Portillo-Márquez, M, Rezola-Arcelus, E, Centeno-Malfaz, F, Solana-Gracia, R, Rojo-Sombrero, H, Cantero-Tejedor, MT, Riaño, B, Tejero-Hernández, MA, Jiménez-Casso, M, Sabaté-Rotés, A
Tipo de recurso:	artículo
Estado:	Versión publicada
Fecha de publicación:	2026
País:	España
Institución:	Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
Repositorio:	r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
OAI Identifier:	oai:dnet:r-iibsantpa_::ad562d53802deabda3aa71c11c025b7e
Acceso en línea:	https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=21468
Access Level:	acceso abierto
Palabra clave:	Ascending aorta dilatati on Bicuspid aortic va lve Body surface a rea Nomograms Pediatrics

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spelling	Defining ascending aorta dilatation in pediatric bicuspid aortic valve: Comparison of known classical and new z-score nomograms, and anthropometric parameters indexing for its assessmentFreixa-Benavente, AJuzga-Corrales, CAyerza-Casas, AFigueras-Coll, MEscribà-Bori, SPlata-Izquierdo, BCollell, RGonzález-Marín, MASiurana, JMSorlí-García, Mde la Torre, LTeodoro-Marín, SRodriguez, MDomínguez-García, ORellán, SManso, BLópez-Abel, BAlvarez-Pérez, RPortillo-Márquez, MRezola-Arcelus, ECenteno-Malfaz, FSolana-Gracia, RRojo-Sombrero, HCantero-Tejedor, MTRiaño, BTejero-Hernández, MAJiménez-Casso, MSabaté-Rotés, AAscending aorta dilatati onBicuspid aortic va lveBody surface a reaNomogramsPediatricsBackground: Ascending aorta (AscAo) dilatation assessment and definition in pediatric bicuspid aortic valve (BAV) is challenging. We compared the Pediatric Heart Network (PHN) nomogram against the Halifax (HZ) one and analyzed their association with body surface area indexing (BSAI). Methods: Echocardiographies from a national BAV registry were analyzed. AscAo and sinus of Valsalva, standardized using nomograms and BSAI, were compared by correlation and Bland-Altman tests. Nomogram +2 and + 3 z-scores thresholds contrasted against >21 mm/BSA-m2 by logistic regression and kappa agreement index. Age subgroup analysis was between adult-size (>= 10 years and BSA >= 1.5 m(2)) and small children. Results: A total 3858 reports were analyzed. The PHN nomogram resulted in higher AscAo z-scores (median 1.516 versus 1.413). Nomogram correlation was Rho(Spearman) = 0.979 and Bland-Altman agreement bias was 0.302, with higher divergence in extreme z-scores. Patients >= 10 years and BSA >= 1.5 m(2) showed better concordance (bias -0.212 versus 0.440) despite similar correlation to the younger group. There was moderate but significant correlation amongst AscAo BSA-indexed diameters and PHN (Rho(Spearman) = 0.514, p < 0.001) and HZ nomograms (Rho(Spearman) = 0.366, p < 0.001), being higher in the older cohort than the younger, both by PHN (Rho(Spearmam) 0.961 versus 0.424) and HZ (Rho(Spearman) 0.952 versus 0.540). Higher area under the curve was obtained by PHN. A lower percentage was classified as dilated with PHN than by BSA-I in the adult-size cohort, but not in younger patients. Discussion: There was good correlation and concordance between HZ and PHN nomograms, the latter resulting in higher z-scores. PHN has better agreement with BSA-I than HZ, with the PHN > +3 z-score threshold being the highest predictor for BSA-I dilatation definition, also showing higher specificity and sensitivity. BSA-I classified fewer patients as dilated than nomograms in adult-sized children but not in the younger cohort. Clinicians should be aware of this effect of BSA when normalizing diameters. (c) 2025 Japanese College of Cardiology. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).ELSEVIER2026info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=21468Journal of CardiologyISSN: 09145087ISSNe: 18764738reponame:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pauinstname:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)Inglésinfo:eu-repo/semantics/openAccessoai:dnet:r-iibsantpa_::ad562d53802deabda3aa71c11c025b7e2026-06-14T12:41:47Z
dc.title.none.fl_str_mv	Defining ascending aorta dilatation in pediatric bicuspid aortic valve: Comparison of known classical and new z-score nomograms, and anthropometric parameters indexing for its assessment
title	Defining ascending aorta dilatation in pediatric bicuspid aortic valve: Comparison of known classical and new z-score nomograms, and anthropometric parameters indexing for its assessment
spellingShingle	Defining ascending aorta dilatation in pediatric bicuspid aortic valve: Comparison of known classical and new z-score nomograms, and anthropometric parameters indexing for its assessment Freixa-Benavente, A Ascending aorta dilatati on Bicuspid aortic va lve Body surface a rea Nomograms Pediatrics
title_short	Defining ascending aorta dilatation in pediatric bicuspid aortic valve: Comparison of known classical and new z-score nomograms, and anthropometric parameters indexing for its assessment
title_full	Defining ascending aorta dilatation in pediatric bicuspid aortic valve: Comparison of known classical and new z-score nomograms, and anthropometric parameters indexing for its assessment
title_fullStr	Defining ascending aorta dilatation in pediatric bicuspid aortic valve: Comparison of known classical and new z-score nomograms, and anthropometric parameters indexing for its assessment
title_full_unstemmed	Defining ascending aorta dilatation in pediatric bicuspid aortic valve: Comparison of known classical and new z-score nomograms, and anthropometric parameters indexing for its assessment
title_sort	Defining ascending aorta dilatation in pediatric bicuspid aortic valve: Comparison of known classical and new z-score nomograms, and anthropometric parameters indexing for its assessment
dc.creator.none.fl_str_mv	Freixa-Benavente, A Juzga-Corrales, C Ayerza-Casas, A Figueras-Coll, M Escribà-Bori, S Plata-Izquierdo, B Collell, R González-Marín, MA Siurana, JM Sorlí-García, M de la Torre, L Teodoro-Marín, S Rodriguez, M Domínguez-García, O Rellán, S Manso, B López-Abel, B Alvarez-Pérez, R Portillo-Márquez, M Rezola-Arcelus, E Centeno-Malfaz, F Solana-Gracia, R Rojo-Sombrero, H Cantero-Tejedor, MT Riaño, B Tejero-Hernández, MA Jiménez-Casso, M Sabaté-Rotés, A
author	Freixa-Benavente, A
author_facet	Freixa-Benavente, A Juzga-Corrales, C Ayerza-Casas, A Figueras-Coll, M Escribà-Bori, S Plata-Izquierdo, B Collell, R González-Marín, MA Siurana, JM Sorlí-García, M de la Torre, L Teodoro-Marín, S Rodriguez, M Domínguez-García, O Rellán, S Manso, B López-Abel, B Alvarez-Pérez, R Portillo-Márquez, M Rezola-Arcelus, E Centeno-Malfaz, F Solana-Gracia, R Rojo-Sombrero, H Cantero-Tejedor, MT Riaño, B Tejero-Hernández, MA Jiménez-Casso, M Sabaté-Rotés, A
author_role	author
author2	Juzga-Corrales, C Ayerza-Casas, A Figueras-Coll, M Escribà-Bori, S Plata-Izquierdo, B Collell, R González-Marín, MA Siurana, JM Sorlí-García, M de la Torre, L Teodoro-Marín, S Rodriguez, M Domínguez-García, O Rellán, S Manso, B López-Abel, B Alvarez-Pérez, R Portillo-Márquez, M Rezola-Arcelus, E Centeno-Malfaz, F Solana-Gracia, R Rojo-Sombrero, H Cantero-Tejedor, MT Riaño, B Tejero-Hernández, MA Jiménez-Casso, M Sabaté-Rotés, A
author2_role	author author author author author author author author author author author author author author author author author author author author author author author author author author author
dc.subject.none.fl_str_mv	Ascending aorta dilatati on Bicuspid aortic va lve Body surface a rea Nomograms Pediatrics
topic	Ascending aorta dilatati on Bicuspid aortic va lve Body surface a rea Nomograms Pediatrics
description	Background: Ascending aorta (AscAo) dilatation assessment and definition in pediatric bicuspid aortic valve (BAV) is challenging. We compared the Pediatric Heart Network (PHN) nomogram against the Halifax (HZ) one and analyzed their association with body surface area indexing (BSAI). Methods: Echocardiographies from a national BAV registry were analyzed. AscAo and sinus of Valsalva, standardized using nomograms and BSAI, were compared by correlation and Bland-Altman tests. Nomogram +2 and + 3 z-scores thresholds contrasted against >21 mm/BSA-m2 by logistic regression and kappa agreement index. Age subgroup analysis was between adult-size (>= 10 years and BSA >= 1.5 m(2)) and small children. Results: A total 3858 reports were analyzed. The PHN nomogram resulted in higher AscAo z-scores (median 1.516 versus 1.413). Nomogram correlation was Rho(Spearman) = 0.979 and Bland-Altman agreement bias was 0.302, with higher divergence in extreme z-scores. Patients >= 10 years and BSA >= 1.5 m(2) showed better concordance (bias -0.212 versus 0.440) despite similar correlation to the younger group. There was moderate but significant correlation amongst AscAo BSA-indexed diameters and PHN (Rho(Spearman) = 0.514, p < 0.001) and HZ nomograms (Rho(Spearman) = 0.366, p < 0.001), being higher in the older cohort than the younger, both by PHN (Rho(Spearmam) 0.961 versus 0.424) and HZ (Rho(Spearman) 0.952 versus 0.540). Higher area under the curve was obtained by PHN. A lower percentage was classified as dilated with PHN than by BSA-I in the adult-size cohort, but not in younger patients. Discussion: There was good correlation and concordance between HZ and PHN nomograms, the latter resulting in higher z-scores. PHN has better agreement with BSA-I than HZ, with the PHN > +3 z-score threshold being the highest predictor for BSA-I dilatation definition, also showing higher specificity and sensitivity. BSA-I classified fewer patients as dilated than nomograms in adult-sized children but not in the younger cohort. Clinicians should be aware of this effect of BSA when normalizing diameters. (c) 2025 Japanese College of Cardiology. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
publishDate	2026
dc.date.none.fl_str_mv	2026
dc.type.none.fl_str_mv	info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion
format	article
status_str	publishedVersion
dc.identifier.none.fl_str_mv	https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=21468
url	https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=21468
dc.language.none.fl_str_mv	Inglés
language_invalid_str_mv	Inglés
dc.rights.none.fl_str_mv	info:eu-repo/semantics/openAccess
eu_rights_str_mv	openAccess
dc.publisher.none.fl_str_mv	ELSEVIER
publisher.none.fl_str_mv	ELSEVIER
dc.source.none.fl_str_mv	Journal of Cardiology ISSN: 09145087 ISSNe: 18764738 reponame:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau instname:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
instname_str	Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
reponame_str	r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
collection	r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
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Defining ascending aorta dilatation in pediatric bicuspid aortic valve: Comparison of known classical and new z-score nomograms, and anthropometric parameters indexing for its assessment

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