Left Ventricular Measurements and Strain in Pediatric Patients Evaluated for Systemic Hypertension and the Effect of Adequate Anti-hypertensive Treatment.
Hypertension
Left ventricular mass index
Left ventricular strain
Obesity
Journal
Pediatric cardiology
ISSN: 1432-1971
Titre abrégé: Pediatr Cardiol
Pays: United States
ID NLM: 8003849
Informations de publication
Date de publication:
Jan 2022
Jan 2022
Historique:
received:
17
05
2021
accepted:
08
08
2021
pubmed:
25
8
2021
medline:
21
1
2022
entrez:
24
8
2021
Statut:
ppublish
Résumé
Pediatric hypertension (HTN) is an epidemic that is associated with HTN in adulthood and adverse cardiovascular outcomes. We hypothesized that children with HTN would have left ventricular (LV) hypertrophy and abnormal LV global longitudinal strain (GLS) on echocardiogram and that these values would differ by weight, race, and HTN treatment. Data were collected from first visits to the HTN Program from 12/2011 to 9/2018, excluding patients with cardiac disease or heart transplantation. LV measurements including LV mass index (LVMI), LV GLS, and diastolic indices were compared between groups. Multivariable logistic regression was used to identify risk factors for an abnormal LVMI. There were 212 patients with an interquartile age range of 13-18 years. On univariate analysis, LVMI was higher in hypertensive, obese, and African American patients. LV strain was less negative in obese and African American patients. Adequately treated patients with HTN had a higher LVMI and a higher E/e' ratio compared to patients with no HTN. On multivariate analysis, only obesity was associated with an LVMI ≥ 95th percentile (OR 2.9, 95% CI 1.4, 5.8). LVMI is higher in hypertensive, obese, and African American patients; however, in the multivariate analysis, obesity was the only independent risk factor for an abnormal LVMI. LVMI was still higher in those adequately treated for HTN compared to patients without HTN, possibly due to concomitant obesity. Future studies should focus on subclinical changes in LV performance seen in obese and hypertensive patients and the impact on long-term health.
Identifiants
pubmed: 34426850
doi: 10.1007/s00246-021-02706-x
pii: 10.1007/s00246-021-02706-x
doi:
Substances chimiques
Antihypertensive Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
155-163Informations de copyright
© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Références
Sun SS, Grave GD, Siervogel RM, Pickoff AA, Arslanian SS, Daniels SR (2007) Systolic blood pressure in childhood predicts hypertension and metabolic syndrome later in life. Pediatrics 119(2):237–246
doi: 10.1542/peds.2006-2543
Berenson GS, Srinivasan SR, Xu JH, Chen W (2016) Adiposity and cardiovascular risk factor variables in childhood are associated with premature death from coronary heart disease in adults: the Bogalusa Heart Study. Am J Med Sci 352(5):448–454
doi: 10.1016/j.amjms.2016.08.006
Hansen ML, Gunn PW, Kaelber DC (2007) Underdiagnosis of hypertension in children and adolescents. JAMA 298(8):874–879
doi: 10.1001/jama.298.8.874
Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR et al (2017) Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics 140(3)
Levy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP (1990) Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med 322(22):1561–1566
doi: 10.1056/NEJM199005313222203
Levy D (1989) Left ventricular mass and incidence of coronary heart disease in an elderly cohort: the Framingham Heart Study. Ann Intern Med 110(2):101
doi: 10.7326/0003-4819-110-2-101
Brown DW, Giles WH, Croft JB (2000) Left ventricular hypertrophy as a predictor of coronary heart disease mortality and the effect of hypertension. Am Heart J 140(6):848–856
doi: 10.1067/mhj.2000.111112
Daniels SR, Loggie JMH, Khoury P, Kimball TR (1998) Left ventricular geometry and severe left ventricular hypertrophy in children and adolescents with essential hypertension. Circulation 97(19):1907–1911
doi: 10.1161/01.CIR.97.19.1907
Hanevold C, Waller J, Daniels S, Portman R, Sorof J (2004) The effects of obesity, gender, and ethnic group on left ventricular hypertrophy and geometry in hypertensive children: a collaborative study of the International Pediatric Hypertension Association. Pediatrics 113(2):328–333
doi: 10.1542/peds.113.2.328
Urbina EM, Gidding SS, Weihang B, Pickoff AS, Kaliope B, Berenson Gerald S (1995) Effect of body size, ponderosity, and blood pressure on left ventricular growth in children and young adults in the Bogalusa Heart Study. Circulation 91(9):2400–2406
doi: 10.1161/01.CIR.91.9.2400
Kaplinski M, Griffis H, Liu F, Tinker C, Laney NC, Mendoza M et al (2020) Clinical innovation: a multidisciplinary program for the diagnosis and treatment of systemic hypertension in children and adolescents. Clin Pediatr (Phila) 59(3):228–235
doi: 10.1177/0009922819898180
Flynn JT, Daniels SR, Hayman LL, Maahs DM, McCrindle BW, Mitsnefes M et al (2014) Update: ambulatory blood pressure monitoring in children and adolescents: a scientific statement from the American Heart Association. Hypertension 63(5):1116–1135
doi: 10.1161/HYP.0000000000000007
Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I et al (1986) Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 57(6):450–458
doi: 10.1016/0002-9149(86)90771-X
National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (2004) The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114(Supplement 2):555–576
doi: 10.1542/peds.114.S2.555
Khoury PR, Mitsnefes M, Daniels SR, Kimball TR (2009) Age-specific reference intervals for indexed left ventricular mass in children. J Am Soc Echocardiogr 22(6):709–714
doi: 10.1016/j.echo.2009.03.003
Nishimura RA, Abel MD, Hatle LK, Tajik AJ (1989) Assessment of diastolic function of the heart: background and current applications of Doppler echocardiography. Part II. Clinical studies. Mayo Clin Proc 64(2):181–204
doi: 10.1016/S0025-6196(12)65673-0
Nagueh SF, Smiseth OA, Appleton CP, Byrd BF, Dokainish H, Edvardsen T et al (2016) Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 29(4):277–314
doi: 10.1016/j.echo.2016.01.011
Kharod AM, Ramlogan SR, Kumar S, Raghuveer T, Drake W, Dai H et al (2014) Childhood obesity increases left-ventricular mass irrespective of blood pressure status. Pediatr Cardiol 35(2):353–360
doi: 10.1007/s00246-013-0782-5
Friberg P (2004) Increased left ventricular mass in obese adolescents. Eur Heart J 25(11):987–992
doi: 10.1016/j.ehj.2004.03.018
Lauer MS, Anderson KM, Kannel WB, Levy D (1991) The impact of obesity on left ventricular mass and geometry: the Framingham Heart Study. JAMA 266(2):231–236
doi: 10.1001/jama.1991.03470020057032
Lopez L, Colan S, Stylianou M, Granger S, Trachtenberg F, Frommelt P et al (2017) Relationship of echocardiographic Z scores adjusted for body surface area to age, sex, race, and ethnicity: the Pediatric Heart Network Normal Echocardiogram Database. Circ Cardiovasc Imaging 10(11)
Daniels SD, Meyer RA, Loggie JM (1990) Determinants of cardiac involvement in children and adolescents with essential hypertension. Circulation 82(4):1243–1248
doi: 10.1161/01.CIR.82.4.1243
Ramaswamy P, Chikkabyrappa S, Donda K, Osmolovsky M, Rojas M, Rafii D (2016) Relationship of ambulatory blood pressure and body mass index to left ventricular mass index in pediatric patients with casual hypertension. J Am Soc Hypertens 10(2):108–114
doi: 10.1016/j.jash.2015.11.009
Brady TM (2016) The role of obesity in the development of left ventricular hypertrophy among children and adolescents. Curr Hypertens Rep 18(1):3
doi: 10.1007/s11906-015-0608-3
Pruette CS, Fivush BA, Flynn JT, Brady TM (2013) Effects of obesity and race on left ventricular geometry in hypertensive children. Pediatr Nephrol 28(10):2015–2022
doi: 10.1007/s00467-013-2507-7
González A, Ravassa S, López B, Moreno MU, Beaumont J, San José G et al (2018) Myocardial remodeling in hypertension. Hypertension 72(3):549–558
doi: 10.1161/HYPERTENSIONAHA.118.11125
Devereux RB, Dahlöf B, Gerdts E, Boman K, Nieminen MS, Papademetriou V et al (2004) Regression of hypertensive left ventricular hypertrophy by losartan compared with atenolol. Circulation 110(11):1456–1462
doi: 10.1161/01.CIR.0000141573.44737.5A
de Luca N, Mallion J-M, O’Rourke MF, O’Brien E, Rahn K-H, Trimarco B et al (2004) Regression of left ventricular mass in hypertensive patients treated with perindopril/indapamide as a first-line combination. The REASON echocardiography study. Am J Hypertens 17(8):660–667
pubmed: 15323062
Gosse P, Sheridan DJ, Zannad F, Dubourg O, Guéret P, Karpov Y et al (2000) Regression of left ventricular hypertrophy in hypertensive patients treated with indapamide SR 1.5 mg versus enalapril 20 mg: the LIVE study. J Hypertens 18(10):1465
doi: 10.1097/00004872-200018100-00015
De Simone G, Devereux RB, Izzo R, Girfoglio D, Lee ET, Howard BV et al (2013) Lack of reduction of left ventricular mass in treated hypertension: the Strong Heart Study. J Am Heart Assoc 2(3)
Kulkarni A, Gulesserian T, Lorenzo JMMD, Haroonian Y, Ngyuyen M, Lo Y et al (2018) Left ventricular remodeling and vascular adaptive changes in adolescents with obesity. Pediatr Obes 13(9):541–549
doi: 10.1111/ijpo.12278
Tadic M, Cuspidi C, Radojkovic J, Rihor B, Kocijanic V, Celic V (2017) Masked hypertension and left atrial dysfunction: a hidden association. J Clin Hypertens 19(3):305–311
doi: 10.1111/jch.12901
Thavendiranathan P, Poulin F, Lim K-D, Plana JC, Woo A, Marwick TH (2014) Use of myocardial strain imaging by echocardiography for the early detection of cardiotoxicity in patients during and after cancer chemotherapy. J Am Coll Cardiol 63(25):2751–2768
doi: 10.1016/j.jacc.2014.01.073
Iso T, Takahashi K, Yazaki K, Ifuku M, Nii M, Fukae T et al (2019) In-depth insight into the mechanisms of cardiac dysfunction in patients with type 1 diabetes mellitus using layer-specific strain analysis. Circ J 83:1330–1337
doi: 10.1253/circj.CJ-18-1245
Dini FL, Fabiani I, Miccoli M, Galeotti GG, Pugliese NR, D’Agostino A et al (2018) Prevalence and determinants of left ventricular diastolic dysfunction in obese subjects and the role of left ventricular global longitudinal strain and mass normalized to height. Echocardiography 35(8):1124–1131
doi: 10.1111/echo.13890
Mawad W, Friedberg MK (2017) The continuing challenge of evaluating diastolic function by echocardiography in children: developing concepts and newer modalities. Curr Opin Cardiol 32(1):93–100
doi: 10.1097/HCO.0000000000000346