Z-score Pulmonary Artery (CHD Reference Model): Explanation and Clinical Context Z-score of the pulmonary artery is a dimensionless value that expresses how many standard deviations an individual’s pulmonary artery diameter deviates from the predicted mean for a given body size.
In patients with congenital heart disease (CHD), accurate assessment of pulmonary artery size is crucial for surgical planning, prosthesis sizing, and postoperative evaluation.
The CHD reference model uses an allometric regression equation based on large multicenter echocardiographic cohorts, where the expected MPA diameter (mm) is estimated by the formula: MPA_predicted = 18.0 × BSA0.5, with a standard deviation of SD = 1.9 × BSA0.5.
These coefficients are derived from morphometric data of both normal children and patients with congenital cardiac anomalies, allowing robust estimation across a wide BSA spectrum (0.3–2.5 m²).
A Z-score between -2 and +2 represents a normal pulmonary artery size distribution.
A Z-score < -2 indicates hypoplasia or underdevelopment, often associated with conditions such as pulmonary stenosis or Tetralogy of Fallot.
A Z-score > +2 may indicate dilation, frequently observed in postoperative or shunt-related cases, or in the setting of elevated pulmonary flow and pressure.
This standardized Z-score calculation improves inter-patient comparison and helps predict surgical outcomes or postoperative pulmonary complications in CHD management.
Reference:
Cantinotti M, Giordano R, Assanta N, Scalese M, Molinaro S, Murzi B, Iervasi G. Nomograms for pulmonary artery diameters in children with and without congenital heart disease: A multicenter echocardiographic study. J Am Soc Echocardiogr. 2014;27(9):925–936. doi:10.1016/j.echo.2014.05.007
Loomba RS, Nielsen JC. Z-scores for pulmonary artery size assessment: Why they matter in congenital heart disease. Pediatr Cardiol. 2020;41(7):1364–1372. doi:10.1007/s00246-020-02373-3