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Heffernan KS, Lefferts WK, Atallah-Yunes NH, Glasgow AC, Gump BB. Racial Differences in Left Ventricular Mass and Wave Reflection Intensity in Children. Front Pediatr 2020; 8:132. [PMID: 32296669 PMCID: PMC7138203 DOI: 10.3389/fped.2020.00132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 03/10/2020] [Indexed: 12/14/2022] Open
Abstract
The burden of heart failure is disproportionately higher in African Americans, with a higher prevalence seen at an early age. Examination of racial differences in left ventricular mass (LVM) in childhood may offer insight into risk for cardiac target organ damage (cTOD) in adulthood. Central hemodynamic load, a harbinger of cTOD in adults, is higher in African Americans. The purpose of this study was to examine racial differences in central hemodynamic load and LVM in African American and non-Hispanic white (NHW) children. Two hundred sixty-nine children participated in this study (age, 10 ± 1 years; n = 149 female, n = 154 African American). Carotid pulse wave velocity (PWV), forward wave intensity (W1) and reflected wave intensity (negative area, NA) was assessed from simultaneously acquired distension and flow velocity waveforms using wave intensity analysis (WIA). Wave reflection magnitude was calculated as NA/W1. LVM was assessed using standard 2D echocardiography and indexed to height as LVM/[height (2.16) + 0.09]. A cutoff of 45 g/m (2.16) was used to define left ventricular hypertrophy (LVH). LVM was higher in African American vs. NHW children (39.2 ± 8.0 vs. 37.2 ± 6.7 g/m (2.16), adjusted for age, sex, carotid systolic pressure and socioeconomic status; p < 0.05). The proportion of LVH was higher in African American vs. NHW children (25 vs. 12 %, p < 0.05). African American and NHW children did not differ in carotid PWV (3.5 ± 4.9 vs. 3.3 ± 1.3 m/s; p > 0.05). NA/W1 was higher in African American vs. NHW children (8.5 ± 5.3 vs. 6.7 ± 2.9; p < 0.05). Adjusting for NA/W1 attenuated racial differences in LVM (38.8 ± 8.0 vs. 37.6 ± 7.0 g/m (2.16); p = 0.19). In conclusion, racial differences in central hemodynamic load and cTOD are present in childhood. African American children have greater wave intensity from reflected waves and higher LVMI compared to NHW children. WIA offers novel insight into early life origins of racial differences in central hemodynamic load and cTOD.
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Affiliation(s)
- Kevin S Heffernan
- Department of Exercise Science, Syracuse University, Syracuse, NY, United States
| | - Wesley K Lefferts
- Division of Academic Internal Medicine, Department of Medicine, University of Illinois-Chicago, Chicago, IL, United States
| | - Nader H Atallah-Yunes
- Division of Pediatric Cardiology, SUNY Upstate Medical University, Syracuse, NY, United States
| | - Alaina C Glasgow
- Department of Exercise Science, Syracuse University, Syracuse, NY, United States
| | - Brooks B Gump
- Department of Public Health, Syracuse University, Syracuse, NY, United States
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Affiliation(s)
- Pamela S Singer
- Cohen Children's Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 269-01 76th Avenue, New Hyde Park, NY 11040, USA.
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Urbina EM, Mendizábal B, Becker RC, Daniels SR, Falkner BE, Hamdani G, Hanevold C, Hooper SR, Ingelfinger JR, Lanade M, Martin LJ, Meyers K, Mitsnefes M, Rosner B, Samuels J, Flynn JT. Association of Blood Pressure Level With Left Ventricular Mass in Adolescents. Hypertension 2019; 74:590-596. [PMID: 31327264 DOI: 10.1161/hypertensionaha.119.13027] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Hypertension is associated with left ventricular hypertrophy (LVH), a risk factor for cardiovascular events. Since cardiovascular events in youth are rare, hypertension has historically been defined by the 95th percentile of the normal blood pressure (BP) distribution in healthy children. The optimal BP percentile associated with LVH in youth is unknown. We aimed to determine the association of systolic BP (SBP) percentile, independent of obesity, on left ventricular mass index (LVMI), and to estimate which SBP percentile best predicts LVH in youth. We evaluated SBP, anthropometrics, and echocardiogram in 303 adolescents (mean age 15.6 years, 63% white, 55% male) classified by SBP as low-risk (L=141, <80th percentile), mid-risk (M=71, 80-<90th percentile), or high-risk (H=91, ≥90th percentile) using the mean of 6 measurements at 2 visits according to the 2017 guidelines. Logistic regression was used to determine the sensitivity and specificity of various SBP percentiles associated with LVH. Results: BP groups did not differ by age or demographics but differed slightly by body mass index. Mean BP, LVMI, and prevalence of LVH increased across groups (BP: L=111/75, M=125/82, and H=133/92 mm Hg; LVMI: L=31.2, M=34.2, and H=34.9 g/m2.7; LVH: L=13%, M=21%, H=27%, all P<0.03). SBP percentile remained a significant determinant of LVMI after adjusting for covariates. The 90th percentile for SBP resulted in the best balance between sensitivity and specificity for predicting LVH (LVMI≥38.6 g/m2.7). Abnormalities in cardiac structure in youth can be found at BP levels below those used to define hypertension.
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Affiliation(s)
- Elaine M Urbina
- From the Division of Preventive Cardiology (E.M.U.), Cincinnati Children's Hospital Medical Center, OH
| | | | - Richard C Becker
- Heart, Lung and Vascular Institute, University of Cincinnati College of Medicine, OH (R.C.B.)
| | - Steve R Daniels
- Department of Pediatrics, Denver Children's Hospital, CO (S.D.)
| | - Bonita E Falkner
- Departments of Medicine and Pediatrics, Thomas Jefferson University, Philadelphia, PA (B.E.F.)
| | - Gilad Hamdani
- Schneider Children's Medical Center of Israel, Tel Aviv, Israel (G.H.)
| | - Coral Hanevold
- Division of Nephrology; Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine (C.H., J.T.F.)
| | - Stephen R Hooper
- Department of Allied Health Sciences, University of North Carolina School of Medicine (S.R.H.)
| | - Julie R Ingelfinger
- Department of Pediatrics, Harvard Medical School, Mass General Hospital for Children, Massachusetts General Hospital, Boston (J.R.I.)
| | - Marc Lanade
- Department of Pediatrics, University of Rochester Medical Center, NY (M.L.)
| | - Lisa J Martin
- Division of Human Genetics (L.J.M.), Cincinnati Children's Hospital Medical Center, OH
| | - Kevin Meyers
- Division of Nephrology and Hypertension, Children's Hospital of Philadelphia, PA (K.M.)
| | - Mark Mitsnefes
- Division of Nephrology and Hypertension (M.M.), Cincinnati Children's Hospital Medical Center, OH
| | | | - Joshua Samuels
- Pediatric Nephrology & Hypertension, McGovern Medical School at the University of Texas in Houston (J.S.)
| | - Joseph T Flynn
- Division of Nephrology; Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine (C.H., J.T.F.)
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Shilly S, Merchant K, Singer P, Frank R, Gurusinghe S, Infante L, Sethna CB. Left ventricular cardiac geometry and ambulatory blood pressure in children. J Clin Hypertens (Greenwich) 2019; 21:566-571. [PMID: 30980607 PMCID: PMC8030399 DOI: 10.1111/jch.13540] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 03/18/2019] [Accepted: 03/28/2019] [Indexed: 01/19/2023]
Abstract
Limited information is available regarding the relationship between ambulatory blood pressure monitoring (ABPM) and cardiac geometry in hypertensive children. ABPM and 2D-echocardiography were retrospectively reviewed in children and adolescents <21 years old with primary hypertension. A total of 119 participants (median age 15.0 [IQR 12, 16] years) with hypertension were included. Left ventricular hypertrophy was diagnosed in 39.5% of participants. Normal geometry was found in 47.1%, concentric remodeling (CR) in 13.4%, concentric hypertrophy (CH) in 15.1%, and eccentric hypertrophy (EH) in 24.4% of children. After adjustment for age, sex, and body mass index z-score, awake systolic blood pressure (BP) index (BPi) (OR 1.07, 95% CI: 1.001-1.14, P = 0.045), awake diastolic BPi (OR 1.04, 95% CI: 1.00-1.09, P = 0.048), awake systolic BP load (OR 1.02, 95% CI: 1.000-1.04, P = 0.047), and sleep systolic BP load (OR 1.02, 95% CI: 1.001-1.04, P = 0.03) were directly associated with CH. No ABPM parameters were significant predictors of EH. In conclusion, ABPM parameters were found to be independent predictors of cardiac geometry, specifically CH.
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Affiliation(s)
- Steffi Shilly
- Department of Pediatrics, Division of Pediatric NephrologyCohen Children's Medical CenterNew Hyde ParkNew York
| | - Kumail Merchant
- Department of Pediatrics, Division of Pediatric NephrologyCohen Children's Medical CenterNew Hyde ParkNew York
| | - Pamela Singer
- Department of Pediatrics, Division of Pediatric NephrologyCohen Children's Medical CenterNew Hyde ParkNew York
| | - Rachel Frank
- Department of Pediatrics, Division of Pediatric NephrologyCohen Children's Medical CenterNew Hyde ParkNew York
| | - Shari Gurusinghe
- Department of Pediatrics, Division of Pediatric NephrologyCohen Children's Medical CenterNew Hyde ParkNew York
| | - Lulette Infante
- Department of Pediatrics, Division of Pediatric NephrologyCohen Children's Medical CenterNew Hyde ParkNew York
| | - Christine B. Sethna
- Department of Pediatrics, Division of Pediatric NephrologyCohen Children's Medical CenterNew Hyde ParkNew York
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Khoury M, Urbina EM. Cardiac and Vascular Target Organ Damage in Pediatric Hypertension. Front Pediatr 2018; 6:148. [PMID: 29881718 PMCID: PMC5976785 DOI: 10.3389/fped.2018.00148] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 05/03/2018] [Indexed: 12/17/2022] Open
Abstract
Atherosclerosis begins in youth and is associated with the presence of numerous modifiable cardiovascular (CV) risk factors, including hypertension. Pediatric hypertension has increased in prevalence since the 1980s but has plateaued in recent years. Elevated blood pressure levels are associated with impairments to cardiac and vascular structure and both systolic and diastolic function. Blood pressure-related increases in left ventricular mass (LVM) and abnormalities in cardiac function are associated with hard CV events in adulthood. In addition to cardiac changes, key vascular changes occur in hypertensive youth and adults. These include thickening of the arteries, increased arterial stiffness, and decreased endothelial function. This review summarizes the epidemiologic burden of pediatric hypertension, its associations with target organ damage (TOD) of the cardiac and vascular systems, and the impact of these adverse CV changes on morbidity and mortality in adulthood.
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Affiliation(s)
| | - Elaine M. Urbina
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
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Cho H, Choi HJ, Kang HG, Ha IS, Cheong HI, Han KH, Kim SH, Cho MH, Shin JI, Lee JH, Park YS. Influence of the Method of Definition on the Prevalence of Left-Ventricular Hypertrophy in Children with Chronic Kidney Disease: Data from the Know-Ped CKD Study. Kidney Blood Press Res 2017; 42:406-415. [PMID: 28689198 DOI: 10.1159/000478867] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 04/24/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Children with chronic kidney disease (CKD) have a high risk of cardiovascular disease. Left-ventricular (LV) hypertrophy (LVH) is an early marker of cardiovascular disease in pediatric CKD, and the prevalence of LVH in pediatric CKD is approximately 20-30% in pre-dialysis CKD patients. However, there is no consensus on the ideal method of defining LVH in pediatric CKD patients. Previous studies have typically used the LV mass index (LVMI), which is calculated as LV mass in grams divided by height in meters to the 2.7th power ≥ 38 g/m2.7, to diagnose LVH in children with CKD. Recently, age-specific reference values for LVMI ≥ 95th percentile and LV wall-thickness z-score > 1.64 in children were addressed. The aim of this study was to assess the prevalence and contributing factors of LVH in pediatric CKD patients according to each measurement and evaluate the concordance between each measurement. METHODS We used the baseline data of the KoreaN cohort study for Outcome in patients With Pediatric Chronic Kidney Disease (KNOW-Ped CKD), which is a nationwide, 10-year, prospective, observational cohort study of pediatric CKD. A total of 469 patients were enrolled, and 458 patients were included in the final analysis. Univariate and multiple logistic regression analysis were performed to evaluate the association of the variables with LVH. Kappa statistics were used to analyze the concordance. RESULTS According to an LVH diagnosis of LVMI ≥ 38 g/m2.7, 188 patients (41.0%) were diagnosed with LVH, and the prevalence of LVH was high in younger patients (< 2 years of age). Using the age-specific reference values, 116 patients (25.3%) were diagnosed with LVH, and there was no difference in the prevalence of LVH according to age. Thirty-one patients (6.8%) were diagnosed with LVH using an LV wall-thickness z-score > 1.64. There is poor concordance between the diagnosis of LVH using the LV wall-thickness z-score and the LVMI method. CONCLUSIONS The results of this study show that there is poor concordance between the diagnosis of LVH using the wall-thickness z-score and the LVMI2.7 criteria. Further investigation is needed to estimate the correlation between LVH and cardiac dysfunction and to find a better method for defining LVH in the pediatric CKD cohort and thereby predicting cardiac dysfunction.
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Affiliation(s)
- Heeyeon Cho
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyun Jin Choi
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Hee Gyung Kang
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Il-Soo Ha
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Hae Il Cheong
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Kyung Hee Han
- Department of Pediatrics, Jeju University Hospital, Jeju, Republic of Korea
| | - Seong Heon Kim
- Department of Pediatrics, Pusan National University Children's Hospital, Yangsan, Republic of Korea
| | - Min Hyun Cho
- Department of Pediatrics, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Severance Children's Hospital, Seoul, Republic of Korea
| | - Joo Hoon Lee
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young Seo Park
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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BUYAN N, AKÇABOY M, GÖKTAŞ T, KULA S, NAZLIEL B, ÇAKAR N, UNCU N, ÇELİK B, ERBAŞ D. Effects of whole blood viscosity and plasma NOx on cardiac function and cerebral blood flow in children with chronic kidney disease. Turk J Med Sci 2017; 47:1482-1491. [DOI: 10.3906/sag-1609-33] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Sethna CB, Leisman DE. Left Ventricular Hypertrophy in Children with Hypertension: in Search of a Definition. Curr Hypertens Rep 2016; 18:65. [DOI: 10.1007/s11906-016-0672-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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10
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Left ventricular mass and cardiac function in pediatric dialysis patients. PROGRESS IN PEDIATRIC CARDIOLOGY 2016. [DOI: 10.1016/j.ppedcard.2015.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Akcaboy M, Kula S, Göktas T, Nazlıel B, Terlemez S, Celik N, Celik B, Buyan N. Effect of plasma NOx values on cardiac function in obese hypertensive and normotensive pediatric patients. Pediatr Nephrol 2016; 31:473-83. [PMID: 26482254 DOI: 10.1007/s00467-015-3223-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 08/09/2015] [Accepted: 09/08/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Hypertension (HT) is a major comorbidity of obesity that is associated with an increased risk of cardiovascular disease and higher mortality. The aim of our study was to evaluate cardiac function in obese hypertensive (OHT) and obese normotensive (ONT) pediatric patients and determine the effects of plasma nitric oxide (NOx) values on cardiac function, while demonstrating the role of plasma NOx in HT in obese pediatric patients. METHODS The study population consisted of 62 patients (27 boys, 35 girls), aged 13-18 years and 21 age-matched healthy controls. All subjects enrolled in the study underwent echocardiography (Echo) evaluation and ambulatory blood pressure monitoring for HT. Plasma NOx and biochemical values were studied in both patient groups separately. RESULTS Plasma NOx levels were found to be lower in the OHT group than in the ONT and control groups (p < 0.001) and to be negatively correlated with left ventricular mass index values (p < 0.05). Both the OHT and ONT groups had concentric hypertrophy of the heart. CONCLUSIONS Plasma NOx plays an essential role in obesity-induced HT. Concentric hypertrophy of the left ventricle was found in both the OHT and ONT groups, indicating structural deformation of the heart.
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Affiliation(s)
- Meltem Akcaboy
- Department of Pediatric Nephrology, Gazi University School of Medicine, Konya yolu, 06500, Besevler, Ankara, Turkey.
| | - Serdar Kula
- Department of Pediatric Cardiology, Gazi University School of Medicine, Ankara, Turkey
| | - Tayfun Göktas
- Department of Physiology, Gazi University School of Medicine, Ankara, Turkey
| | - Bijen Nazlıel
- Department of Neurology, Gazi University School of Medicine, Ankara, Turkey
| | - Semiha Terlemez
- Department of Pediatric Cardiology, Gazi University School of Medicine, Ankara, Turkey
| | - Nurullah Celik
- Department of Pediatric Endocrinology, Gazi University School of Medicine, Ankara, Turkey
| | - Bülent Celik
- Faculty of Science, Department of Biostatistics, Gazi University, Ankara, Turkey
| | - Necla Buyan
- Department of Pediatric Nephrology, Gazi University School of Medicine, Konya yolu, 06500, Besevler, Ankara, Turkey
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