Normal Values for Speckle-Tracking Echocardiography in Children: A Review, Update, and Guide for Clinical Use of Speckle-Tracking Echocardiography in Pediatric Patients

Background/Objectives: While speckle-tracking echocardiography (STE) is increasingly gaining acceptance in the medical community, establishing normal pediatric values and interpreting data derived from software provided by various vendors can pose significant challenges. This review aims to present an updated compilation of nomograms pertinent to speckle-tracking echocardiography. Methods: A review of research using three medical engine searches (National Library of Medicine, Science Direct, and Cochrane Library) for Medical Subject Headings (MeSH) and the free text terms “echocardiography”, “STE”, “normal values”, and ”children” was performed and refined by adding the keywords “nomograms”, “z-scores”, and “healthy children”. Results: A total of twenty-five studies were selected for the final analysis. Our research indicated that current nomograms provide adequate coverage of most strain parameters; however, those pertaining to the right ventricle and the atria are less numerous than those for the left ventricle. A noted trend suggests a decrease in strain values with advancing age and increasing body surface area; nevertheless, the relationships observed were weak and nonlinear. The absence of robust correlations between strain values and age and body size parameters hindered the generation of a Z-score possessing sufficient statistical power. Consequently, normal values are primarily represented as mean values accompanied by standard deviation. A comparative analysis of vendors demonstrated good agreement between different versions of the same platform for Philips (except for QLAB 5) and, similarly, between General Electric (GE) and TomTec. The limited data available regarding the comparison between GE and Philips revealed significant findings that warrant further investigation of differences. Conclusions: A comprehensive review and an updated list of current pediatric nomograms for STE measurements have been presented. This may serve as a valuable guide for accurately interpreting STE in pediatric patients with congenital and acquired heart disease.