The impact of different body surface area prediction equations on ventricular dilatation prevalence in youth soccer players

Marco Alessandro Minetto^1*Elisabetta Toso²Federico Della Vecchia³Andrea Ferraris⁴Massimo Magistrali⁵Gianluca Alunni²Chiara Busso¹Angelo Pietrobelli⁶John Shepherd⁷Steven Heymsfield⁸

• ¹University of Turin, Turin, Italy
• ²Città della Salute e della Scienza Hospital, Turin, Italy
• ³Juventus Football Club, Torino, Italy
• ⁴Politecnico di Torino, Torino, Italy
• ⁵J Medical, Torino, Italy
• ⁶University of Verona, Verona, Italy
• ⁷University of Hawaii, Honolulu, United States
• ⁸Pennington Biomedical Research Center, Baton Rouge, United States

The normalization of echocardiographic variables for body surface area (BSA) enables to obtain relative indexes of ventricular size that are useful for diagnosis and monitoring of nonischaemic cardiomyopathies. The BSA values commonly considered in the clinical practice are obtained using predictive equations. Our aims were to investigate the accuracy of different predictive equations for BSA estimation and to evaluate the impact of different BSA normalizations on ventricular dilatation prevalence in youth soccer players.Methods: Two samples of 369 and 111 youth soccer players of both genders were recruited.Acquisition of optical images (for the players of the first sample), two-dimensional echocardiographic assessment (for the players of the second sample), and weight and height measurements (for the players of both samples) were performed. BSA estimates were derived from optical images and from ten different predictive equations obtained from the literature.In the first sample of 369 players, we found differences among the BSA estimates obtained with ten predictive equations in both male and female players and we also found that all predictive equations in male players and almost all predictive equations in female players overestimated BSA compared to the optical imaging-derived BSA. In the second sample of 111 soccer players, we found that the normalization of each echocardiographic variable for different BSA values resulted in significantly different relative values and that ventricular dilatation prevalence was a function of BSA normalization.Newly developed equations seemed the most accurate for BSA estimation in both male and female players: therefore, we suggest to adopt these equations for BSA estimation in youth soccer players. The BSA normalization impacts on the ventricular dilatation prevalence: therefore, we suggest to adopt the proper normalization approach to improve the clinical validity of echocardiography in athletes.