To characterize sex- and body surface area (BSA)-related distributional patterns and developmental trends of left ventricular (LV) structure and function in healthy early adolescents. This cross-sectional study included 417 healthy children aged 10–13 years, stratified by BSA (0.90–1.20, 1.20–1.50, and 1.50–1.80 m2). LV structural and functional indices were examined using Spearman correlations, kernel density estimation, and generalized additive models (GAMs). GAMs included age and sex as covariates and modeled BSA using sex-specific smooth terms. BSA showed weak positive correlations with LV wall thickness, chamber size, LV mass, and LV volumes, but was inversely correlated with height^2.7-indexed LV mass (ρ = − 0.154), which suggested over-correction by height^2.7 indexation in larger children. Sensitivity analyses using alternative indexation strategies showed consistent inferences. In GAMs, boys showed more pronounced non-linear BSA-related patterns for selected structural indices than girls’ near-linear patterns, while the overall sex-by-BSA interaction was not significant. After adjustment for age and BSA, boys had a smaller left ventricular end-systolic diameter (LVESD) and left ventricular end-systolic volume (LVESV) and modestly higher left ventricular ejection fraction (LVEF) and fractional shortening (FS) than girls, whereas global longitudinal strain (GLS) and early diastolic mitral inflow velocity to mitral annular velocity ratio (E/e′) showed no meaningful sex differences.Conclusions: In healthy early adolescents, LV structure and volumes scale primarily with BSA, whereas LV functional indices are largely stable across the BSA spectrum. Sex differences are small and mainly reflected by a curved shape, supporting the use of BSA-stratified (rather than sex-specific) reference intervals for this age group.<Table Float="No" ID="Taba"> <tgroup cols="1"> <colspec align="left" colname="c1" colnum="1" /> <tbody> <row> <entry align="left" colname="c1"> What is Known: • Early adolescence is a key pubertal growth phase, but data on cardiac adaptation and remodeling are limited. • Current reference systems recommend BSA-based rather than age-based stratification, but whether there are sex differences in BSA levels in early adolescence remains unclear. </entry> </row> <row> <entry align="left" colname="c1"> What is New: • We provide BSA-stratified reference intervals and model BSA-related LV structure/function patterns in early adolescents using kernel density and GAMs. • In early adolescence, sex differences are clinically negligible and mainly at higher BSA, supporting BSA-based rather than age- or sex-specific references. </entry> </row> </tbody> </tgroup> </Table>

Sex- and body surface area-specific distribution and developmental trends of left ventricular structure and function during early adolescence

期刊论文
发表日期：

2026年4月17日

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Yawen Deng,
Liyuan Xu,
Shanshan Li,
Jiao Yang,
Guowen Liu,
Hongju Zhang,
Ruijuan Su,
Li Xue,
Kexin Zhu,
Ning Ma

摘要

To characterize sex- and body surface area (BSA)-related distributional patterns and developmental trends of left ventricular (LV) structure and function in healthy early adolescents. This cross-sectional study included 417 healthy children aged 10–13 years, stratified by BSA (0.90–1.20, 1.20–1.50, and 1.50–1.80 m²). LV structural and functional indices were examined using Spearman correlations, kernel density estimation, and generalized additive models (GAMs). GAMs included age and sex as covariates and modeled BSA using sex-specific smooth terms. BSA showed weak positive correlations with LV wall thickness, chamber size, LV mass, and LV volumes, but was inversely correlated with height^2.7-indexed LV mass (ρ = − 0.154), which suggested over-correction by height^2.7 indexation in larger children. Sensitivity analyses using alternative indexation strategies showed consistent inferences. In GAMs, boys showed more pronounced non-linear BSA-related patterns for selected structural indices than girls’ near-linear patterns, while the overall sex-by-BSA interaction was not significant. After adjustment for age and BSA, boys had a smaller left ventricular end-systolic diameter (LVESD) and left ventricular end-systolic volume (LVESV) and modestly higher left ventricular ejection fraction (LVEF) and fractional shortening (FS) than girls, whereas global longitudinal strain (GLS) and early diastolic mitral inflow velocity to mitral annular velocity ratio (E/e′) showed no meaningful sex differences.

Conclusions: In healthy early adolescents, LV structure and volumes scale primarily with BSA, whereas LV functional indices are largely stable across the BSA spectrum. Sex differences are small and mainly reflected by a curved shape, supporting the use of BSA-stratified (rather than sex-specific) reference intervals for this age group.

What is Known:

• Early adolescence is a key pubertal growth phase, but data on cardiac adaptation and remodeling are limited.

• Current reference systems recommend BSA-based rather than age-based stratification, but whether there are sex differences in BSA levels in early adolescence remains unclear.

What is New:

• We provide BSA-stratified reference intervals and model BSA-related LV structure/function patterns in early adolescents using kernel density and GAMs.

• In early adolescence, sex differences are clinically negligible and mainly at higher BSA, supporting BSA-based rather than age- or sex-specific references.