BACKGROUND : Echocardiographic reference ranges are important to identify abnormalities of cardiac dimensions.
Reference ranges for children in sub-Saharan Africa have not been established. The aim of this study was to
establish echocardiographic z-score references for Black children in sub-Saharan Africa.
METHODS : 282 healthy subjects aged 6–16 years (143 [51%] males)with no known history of cardiac diseasewere
enrolled in the study in Harare, Zimbabwe between 2014 and 2016. Standard M-mode echocardiography was
performed and nine cardiac chamber dimensions were obtained. Two non-linear statistical models (gamma
weighted model and cubic polynomial model) were tested on the data and the best fitting model was used to
calculate z-scores of these cardiac chamber measures. The reference ranges are presented on scatter plots against
RESULTS : Normative data for the following cardiac measures were obtained and z-scores calculated: right ventricular
diameter at end diastole (RVEDD); left ventricular diameter at end diastole (LVEDD) and systole (LVESD);
interventricular septal wall thickness at end diastole (IVSd) and systole (IVSs); left ventricular posterior wall
thickness at end diastole (LVPWd) and systole (LVPWs); left atrium diameter at end systole (LA) and tricuspid
annular plane systolic excursion (TAPSE). Girls had higher values for BMI and heart rate than boys (p = 0.048
and p = 0.001, respectively). Mean interventricular septal and left ventricular posterior walls thickness was
higher than published normal values in predominantly Caucasian populations.
CONCLUSION : These are the first echocardiographic reference ranges for children from sub Saharan Africa and will
allow accurate assessment of cardiac dimensions in clinical practice.