Pediatric Cardiology

, Volume 39, Issue 5, pp 892–901 | Cite as

Validation of Right Atrial Area as a Measure of Right Atrial Size and Normal Values of in Healthy Pediatric Population by Two-Dimensional Echocardiography

  • Hari Rajagopal
  • Santosh C. Uppu
  • Justin Weigand
  • Simon Lee
  • Ruchika Karnik
  • Helen Ko
  • Puneet Bhatla
  • James Nielsen
  • John Doucette
  • Ira Parness
  • Shubhika SrivastavaEmail author
Original Article


Right atrial (RA) size is a prognostic indicator for heart failure and cardiovascular death in adults. Data regarding use of RA area (RAA) by two-dimensional echocardiography as a surrogate for RA size and allometric modeling to define appropriate indexing of the RAA are lacking. Our objective was to validate RAA as a reliable measure of RA size and to define normal reference values by transthoracic echocardiography (TTE) in a large population of healthy children and develop Z-scores using a validated allometric model for indexing RAA independent of age, sex, and body size. Agreement between RAA and volume by 2D, 3D TTE, and MRI was assessed. RAA not volume by 2D TTE is an excellent surrogate for RA size. RAA/BSA1 has an inverse correlation with BSA with a residual relationship to BSA (r = − 0.54, p < 0.0001). The allometric exponent (AE) derived for the entire cohort (0.85) also fails to eliminate the residual relationship. The entire cohort divided into two groups with a BSA cut-off of 1 m2 to provide the best-fit allometric model (r = 0). The AE by least square regression analysis for each group is 0.95 and 0.88 for BSA < 1 m2 and > 1 m2, respectively, and was validated against an independent sample. The mean indexed RAA ± SD for BSA ≤ 1 m2 and > 1 m2 is 9.7 ± 1.3 cm2 and 8.7 ± 1.3 cm2, respectively, and was used to derive Z-scores. RAA by 2D TTE is superior to 2D or 3D echocardiography-derived RA volume as a measure of RA size using CMR as the reference standard. RAA when indexed to BSA1, decreases as body size increases. The best-fit allometric modeling is used to create Z scores. RAA/BSA0.95 for BSA < 1 m2 and RAA/BSA0.88 for those with BSA > 1 m2 can be used to derive Z scores.


Right atrial area Pediatrics Z scores Allometric 



The authors would like to acknowledge Erika Pedri RDCS and Rosalie Castaldo RDCS for echocardiographic measurements.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Hari Rajagopal
    • 1
  • Santosh C. Uppu
    • 1
  • Justin Weigand
    • 1
  • Simon Lee
    • 1
  • Ruchika Karnik
    • 1
  • Helen Ko
    • 1
  • Puneet Bhatla
    • 1
  • James Nielsen
    • 1
  • John Doucette
    • 2
  • Ira Parness
    • 1
  • Shubhika Srivastava
    • 1
    Email author
  1. 1.Department of Pediatric CardiologyIcahn School of Medicine at Mount SinaiNew YorkUSA
  2. 2.BiostatisticsIcahn School of Medicine at Mount SinaiNew YorkUSA

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