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Çetiner N, Akalın F, Erolu E, Bayram T, Haklar G. Evaluation of Arterial Functions and Carotid Intima Media Thickness in Children During Mid-Term Follow-Up After Kawasaki Disease. Turk Arch Pediatr 2022; 56:576-584. [PMID: 35110056 PMCID: PMC8849630 DOI: 10.5152/turkarchpediatr.2021.21135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Kawasaki disease (KD) is a multisystemic vasculitis of medium- and small-sized arteries. The involvement of the coronary arteries may lead to long-term cardiovascular sequelae. We studied the elasticity of the aorta and the common carotid artery (CCA), flowmediated dilatation of the brachial artery, and carotid intima media thickness, as well biomarkers such as high-sensitivity C-reactive protein (hs-CRP) and elastin, as useful indicators of cardiovascular risk in patients, following KD. METHODS The study group consisted of 26 patients with a history of KD, and 26 healthy children. Echocardiography, and carotid and brachial ultrasound studies were performed. Plasma hs- CRP and elastin levels were studied in both groups. RESULTS The stiffness indices (SI) obtained from the aortic arch, abdominal aorta, and the CCA were increased in the patients, compared to the controls. Distensibility was decreased at the sinus of Valsalva, the sinotubular junction, the aortic arch, and the ascending aorta, compared to the control group. Flow-mediated dilatation (FMD) was lower in the patients than in the controls. The age of the patients had a negative correlation to distensibility of the aortic arch and abdominal aorta, and a positive correlation to the stiffness of the aortic arch. Follow-up duration correlated positively to stiffness of the aortic arch. Carotid intima-media thickness (CIMT), serum hs-CRP, and elastin levels did not differ between the groups. CONCLUSION Increased aortic and carotid stiffness and decreased aortic distensibility suggest impaired arterial functions following KD. Long-term follow-up and monitorization early in cardiovascular disease is needed.
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Affiliation(s)
- Nilüfer Çetiner
- Department of Pediatric Cardiology, Koç University School of Medicine, İstanbul, Turkey
| | - Figen Akalın
- Department of Pediatric Cardiology, Marmara University School of Medicine, İstanbul, Turkey
| | - Elif Erolu
- Department of Pediatric Cardiology, Koşuyolu High Specialized Training and Research Hospital, İstanbul, Turkey
| | - Tevfik Bayram
- Department of Public Health, Marmara University School of Medicine, İstanbul Turkey
| | - Goncagül Haklar
- Department of Biochemistry, Marmara University School of Medicine, İstanbul, Turkey
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Karakaya Z, Cavkaytar Ö, Tosun Ö, Arga M. Subclinical cardiovascular dysfunction in children and adolescents with asthma. J Asthma 2020; 59:451-461. [PMID: 33251886 DOI: 10.1080/02770903.2020.1856866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND There is close association between asthma and cardiovascular functions as both diseases share common inflammatory pathways. The current study was aimed at investigating the risk factors, associated with endothelial and cardiac functions in children with newly-diagnosed mild-persistent asthma. METHODS A total of 33 steroid-naive asthmatic children [median(interquartile-range); 9.1 years(7.8-13.5)] and 16 healthy controls [11.5 years(9.9-13.6)] were included. Their demographic, clinical and laboratory findings were recorded. Carotid Artery intima-media thickness (CIMT), stiffness, distensibility and strain were measured as atheroclerosis markers. Conventional and tissue Doppler imaging was performed to evaluate ventricular function. RESULTS The patients with asthma had higher CIMT and stiffness and lower strain and distensibility compared to controls (p < 0.001 for all). There was a significant correlation between the duration of asthmatic symptoms and subclinical-atherosclerosis as well as peripheral eosinophil count (p < 0.001, p < 0.05). The patients had lower tricuspid-annular-plane-systolic-excursion (TAPSE), ejection time, and higher isovolumetric relaxation time (IRT), isovolumetric contraction time (ICT), and left ventricle myocardial performance index (LVMPI) than the control subjects (p < 0.001 for all). A positive correlation was also observed between the duration of asthmatic-symptoms and cardiac-function parameters. CONCLUSION Children with mild persistent asthma had subclinical atherosclerosis and ventricular dysfunction even in the early stage of disease. Symptom duration was closely associated with both subclinical atherosclerosis and ventricular dysfunction. Myocardial performance index was abnormal in the asthmatic children when assessed by tissue Doppler Imaging even though they had normal ejection fraction in conventional echocardiography. Future prospective studies with larger sample sizes are needed to confirm these findings and to assess the possible protective effect of ICSs in the prevention of subclinical atherosclerosis.
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Affiliation(s)
- Zeynep Karakaya
- Department of Pediatrics, Istanbul Medeniyet University Medical Faculty, İstanbul, Turkey
| | - Özlem Cavkaytar
- Department of Pediatric Allergy and Immunology, Istanbul Medeniyet University Medical Faculty, İstanbul, Turkey
| | - Öykü Tosun
- Department of Pediatric Cardiology, Istanbul Medeniyet University Medical Faculty, İstanbul, Turkey
| | - Mustafa Arga
- Department of Pediatric Allergy and Immunology, Istanbul Medeniyet University Medical Faculty, İstanbul, Turkey
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McCrindle BW, Rowley AH, Newburger JW, Burns JC, Bolger AF, Gewitz M, Baker AL, Jackson MA, Takahashi M, Shah PB, Kobayashi T, Wu MH, Saji TT, Pahl E. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association. Circulation 2017; 135:e927-e999. [PMID: 28356445 DOI: 10.1161/cir.0000000000000484] [Citation(s) in RCA: 2137] [Impact Index Per Article: 305.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Kawasaki disease is an acute vasculitis of childhood that leads to coronary artery aneurysms in ≈25% of untreated cases. It has been reported worldwide and is the leading cause of acquired heart disease in children in developed countries. METHODS AND RESULTS To revise the previous American Heart Association guidelines, a multidisciplinary writing group of experts was convened to review and appraise available evidence and practice-based opinion, as well as to provide updated recommendations for diagnosis, treatment of the acute illness, and long-term management. Although the cause remains unknown, discussion sections highlight new insights into the epidemiology, genetics, pathogenesis, pathology, natural history, and long-term outcomes. Prompt diagnosis is essential, and an updated algorithm defines supplemental information to be used to assist the diagnosis when classic clinical criteria are incomplete. Although intravenous immune globulin is the mainstay of initial treatment, the role for additional primary therapy in selected patients is discussed. Approximately 10% to 20% of patients do not respond to initial intravenous immune globulin, and recommendations for additional therapies are provided. Careful initial management of evolving coronary artery abnormalities is essential, necessitating an increased frequency of assessments and escalation of thromboprophylaxis. Risk stratification for long-term management is based primarily on maximal coronary artery luminal dimensions, normalized as Z scores, and is calibrated to both past and current involvement. Patients with aneurysms require life-long and uninterrupted cardiology follow-up. CONCLUSIONS These recommendations provide updated and best evidence-based guidance to healthcare providers who diagnose and manage Kawasaki disease, but clinical decision making should be individualized to specific patient circumstances.
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Nandlall I, Maurice RL, Fournier A, Merouani A, Dahdah N. Ascending Aorta Elastography After Kawasaki Disease Compared to Systemic Hypertension. Pediatr Cardiol 2015; 36:1417-22. [PMID: 25921428 DOI: 10.1007/s00246-015-1175-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 04/18/2015] [Indexed: 10/23/2022]
Abstract
Kawasaki disease (KD) is a systemic vasculitis, classically affecting large- and medium-size arteries. The coronary arteries draw most of the clinical attention, whereas few studies have taken interest in the ascending aorta. Using a proprietary imaging-based mechanical biomarker (ImBioMark), we sought to determine aortic stiffness in KD compared to systemic hypertension (HTN) and healthy children. We evaluated parasternal long-axis views focused on the ascending aorta in 20 controls, 12 KD, and 8 HTN as a comparative clinical model of vascular stiffness. We calculated systolic and diastolic aortic wall strain with ImBioMark. Strain was tested for normality against height, systolic, and diastolic blood pressure in normal subjects. Strain from KD and HTN was normalized (Z score) accordingly. Z score comparisons were performed using nonparametric statistics. Age was similar between KD and HTN (9.1 ± 5.3 and 9.9 ± 5.3 years old; p = NS). Systolic and diastolic strain values were normally distributed against height, systolic blood pressure, and diastolic blood pressure in healthy subjects. HTN subjects had abnormal systolic and diastolic strain values (p < 0.0001). Whereas KD subjects had normal diastolic strain, systolic strain was significantly lower (p < 0.001), and systolic strain was intermediate between controls and HTN. There were no significant differences in aortic strain among KD, however, according to the presence of coronary artery aneurysms. Despite normal blood pressure, the ascending aorta in KD exhibits reduced strain during systole. This may reflect in situ rigidity of the aorta. The normal diastolic strain in KD may, in contrast, reflect normal peripheral vascular resistance.
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Affiliation(s)
- Ian Nandlall
- Division of Pediatric Cardiology (6, Bloc 9), CHU Sainte-Justine, University of Montreal, 3175 Côte Ste-Catherine, Montreal, QC, H3T 1C5, Canada.,Department of Family Medicine, McGill University, Montreal, QC, Canada
| | | | - Anne Fournier
- Division of Pediatric Cardiology (6, Bloc 9), CHU Sainte-Justine, University of Montreal, 3175 Côte Ste-Catherine, Montreal, QC, H3T 1C5, Canada
| | - Aïcha Merouani
- Division of Pediatric Nephrology, CHU Ste-Justine, Montreal, QC, Canada
| | - Nagib Dahdah
- Division of Pediatric Cardiology (6, Bloc 9), CHU Sainte-Justine, University of Montreal, 3175 Côte Ste-Catherine, Montreal, QC, H3T 1C5, Canada. .,CHU Ste-Justine Research Center, Montreal, QC, Canada.
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Ülger Z, Gülen F, Özyürek AR. Abdominal aortic stiffness as a marker of atherosclerosis in childhood-onset asthma: a case-control study. Cardiovasc J Afr 2014; 26:8-12. [PMID: 25268111 PMCID: PMC4392206 DOI: 10.5830/cvja-2014-046] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 08/14/2014] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Asthma is one of the chronic inflammatory diseases. It is known that chronic inflammation accelerates atherosclerosis. Abdominal aortic stiffness parameters can be used to detect the early development of atherosclerosis. AIM In this study, we aimed to evaluate abdominal aortic stiffness parameters in childhood-onset asthma compared with a control group. METHODS In this cross-sectional, case-control study, we evaluated 50 patients with childhood-onset asthma, and 57 healthy children as controls. Patients with a diagnosis of asthma of at least three years' duration were included in the study. Children with hypertension, hyperlipidaemia, diabetes, a history of smoking contact, or systemic disease were excluded. The study and control groups were evaluated with transthoracic echocardiography, and abdominal aorta diameters were measured. Using the measured data, abdominal aortic stiffness parameters (aortic distensibility: DIS, aortic strain: S, pressure strain elastic modulus: Ep, and pressure strain normalised by diastolic pressure: Ep*) were calculated. Statistical evaluation was done with the Student's t-test, chisquared test and Pearson's correlation test. RESULTS The study group consisted of 50 children (24 female, 26 male) with asthma. According to the GINA guidelines, 26 of the patients had mild intermittant asthma, six had mild persistent asthma and 18 had intermediate persistent asthma. None of the patients had severe asthma. In 37 of the asthma patients, spIgE was positive and these patients were accepted as having atopic asthma; 27 of these patients received immunotherapy. We did not detect any differences between the study and control groups in terms of gender, age and body mass index. No differences were evident between the groups with regard to systolic and diastolic blood pressure, heart rate, blood cholesterol levels and respiratory function test parameters. There was no difference between the asthma and control groups in the measurement of abdominal aortic stiffness parameters. There was no significant correlation between aortic stiffness parameters and high-sensitivity C-reactive protein, blood total cholesterol, LDL cholesterol and HDL cholesterol levels. CONCLUSION We did not find any difference between the asthma patients and control group with regard to aortic stiffness parameters (DIS, S, Ep and Ep*) and there was no difference in these parameters when we compared patients with mild asthma with those with moderate asthma. These results may be due to the anti-inflamatory effect of inhaled steroids. Further studies are needed to validate these results.
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Affiliation(s)
- Zülal Ülger
- Ege University Children's Hospital, Izmir, Bornova, Turkey.
| | - Figen Gülen
- Ege University Children's Hospital, Izmir, Bornova, Turkey
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Gupta A, Singh S, Gupta A, Suri D, Rohit M. Aortic stiffness studies in children with Kawasaki disease: preliminary results from a follow-up study from North India. Rheumatol Int 2014; 34:1427-32. [PMID: 24696188 DOI: 10.1007/s00296-014-3000-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 03/24/2014] [Indexed: 11/26/2022]
Abstract
Kawasaki disease (KD) is an acute medium vessel vasculitis seen in children. Coronary artery abnormalities are the most notable long-term complications. Intravenous immunoglobulin therapy has led to significant reduction in incidence of coronary aneurysms. However, higher risk of cardiovascular disease has been noted even in those children who have never been reported to develop coronary artery aneurysms during the subacute phase. Noninvasive estimation of this cardiovascular risk is useful in initiating timely preventive strategies. Arterial stiffness has been shown to be an independent predictor of cardiovascular events in general population. This study was aimed at measuring abdominal aorta stiffness in a cohort of children with KD from North India. Thirty children diagnosed to have KD at least 5 years prior to enrollment were evaluated by echocardiography for cardiac and abdominal aorta studies. Electrocardiographs were done in all patients for QT dispersion. There was a noticeable trend toward lower aortic strain, higher pressure strain elastic modulus and normalized pressure strain elastic modulus in children in the study group, though this difference did not reach statistical significance. Mean corrected QT dispersion was significantly higher in cases compared with controls. On cardiac evaluation, none of the subjects had any residual coronary artery involvement. A trend toward lower distensibility and higher stiffness of abdominal aorta was seen in cases compared with controls, though it was not found to be statistically significant. This could be a predictor of premature atherosclerosis in long term. Significantly higher QT dispersion was seen in cases compared with controls. More multicentric studies with larger sample size and longer follow-up periods are needed to clarify this issue.
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Affiliation(s)
- Anand Gupta
- Pediatric Allergy Immunology Unit, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Louw J, Brown S, Thewissen L, Smits A, Eyskens B, Heying R, Cools B, Levtchenko E, Allegaert K, Gewillig M. Neonatal circulatory failure due to acute hypertensive crisis: clinical and echocardiographic clues. Cardiovasc J Afr 2014; 24:72-5. [PMID: 23736130 PMCID: PMC3721817 DOI: 10.5830/cvja-2013-003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Accepted: 01/11/2013] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Circulatory failure due to acute arterial hypertension in the neonatal period is rare. This study was undertaken to assess the clinical and echocardiographic manifestations of circulatory failure resulting from acute neonatal hypertensive crisis. METHODS Neonatal and cardiology databases from 2007 to 2010 were reviewed. An established diagnosis of circulatory failure due to neonatal hypertension before the age of 14 days was required for inclusion. Six patients were identified. RESULTS Five patients presented with circulatory failure due to an acute hypertensive crisis. The median age at presentation was 8.5 days (range: 6.0-11.0) with a median body weight of 3.58 kg (range: 0.86-4.70). Echocardiography demonstrated mild left ventricular dysfunction [median shortening fraction (SF) 25%, range 10-30] and mild aortic regurgitation in 83% (5/6) of patients. One patient with left ventricular dysfunction (SF = 17%) had a large apical thrombus. Two patients were hypotensive, and hypertension only became evident after restoration of cardiac output. Administration of intravenous milrinone was successful, with rapid improvement of the clinical condition. Left ventricular function normalised in all survivors. CONCLUSION Early neonatal circulatory collapse due to arterial hypertension is a rare but potentially life-threatening condition. At presentation, hypotension, especially in the presence of a dysfunctional left ventricle, does not exclude a hypertensive crisis being the cause of circulatory failure. The echocardiographic presence of mild aortic regurgitation combined with left ventricular hypocontractility in a structurally normal heart should alert the physician to the presence of underlying hypertension.
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Affiliation(s)
- Jacoba Louw
- Paediatric Cardiology, University Hospitals Leuven, Leuven, Belgium
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Vaujois L, Dallaire F, Maurice RL, Fournier A, Houde C, Thérien J, Cartwright D, Dahdah N. The Biophysical Properties of the Aorta Are Altered Following Kawasaki Disease. J Am Soc Echocardiogr 2013; 26:1388-96. [DOI: 10.1016/j.echo.2013.08.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Indexed: 02/01/2023]
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Lim YH, Enkhdorj R, Kim BK, Kim SG, Kim JH, Shin J. Correlation between Proximal Abdominal Aortic Stiffness Measured by Ultrasound and Brachial-Ankle Pulse Wave Velocity. Korean Circ J 2013; 43:391-9. [PMID: 23882288 PMCID: PMC3717422 DOI: 10.4070/kcj.2013.43.6.391] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 05/27/2013] [Accepted: 06/12/2013] [Indexed: 11/21/2022] Open
Abstract
Background and Objectives The proximal portion of the abdominal aorta (AA) is characterized by minimal arteriosclerosis compared with other aortic segments. To assess the clinical usefulness of this characteristic, the correlation between ultrasonographically measured proximal AA stiffness and brachial-ankle pulse wave velocity (baPWV) was examined. Subjects and Methods 285 subjects were analyzed, half with hypertension and half with normal blood pressure. Proximal AA was examined using ultrasonography; strain, distensibility, elastic modulus, and the stiffness index were determined. After adjustment for age, gender, body mass index (BMI), systolic blood pressure (SBP), and heart rate, the relationships between baPWV and all these parameters were tested. Results The mean age of the study subjects was 58.1±12.8 years and the mean BMI was 24.3±3.8 kg/cm2. 58.9% of the subjects were female. 42.8% were hypertensive subjects. Among the hypertensive subjects, 56.0% were taking antihypertensive medication. Adjusted partial correlation coefficients for the relationship between baPWV with strain, distensibility, elastic modulus, and the stiffness index of the proximal AA were -0.203 (p=0.01), -0.121 (p=0.129), 0.304 (p=0.0001), and 0.299 (p=0.0001), respectively, in normotensive subjects. In the multivariate analyses, such correlations were observed mainly in the normotensive group, whereas there was no association among hypertensive subjects regardless of antihypertensive medication status. Conclusion baPWV is moderately correlated with the stiffness parameters for the proximal AA, mainly in normotensive subjects.
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Affiliation(s)
- Young-Hyo Lim
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
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Biteker M, Özden T, Dayan A, Tekkeşin AI, Misirli CH. Aortic Stiffness and Plasma Brain Natriuretic Peptide Predicts Mortality in Acute Ischemic Stroke. Int J Stroke 2013; 10:679-85. [DOI: 10.1111/ijs.12049] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 10/29/2012] [Indexed: 11/28/2022]
Abstract
Background The study aimed to evaluate the prognostic role and discriminative power of aortic stiffness and plasma brain natriuretic peptide levels in a cohort of patients hospitalized for acute ischemic stroke. Methods and Results Three hundred and ten consecutive patients aged 50 years and older with a first episode of acute ischemic stroke were prospectively evaluated. All patients were admitted to the hospital within 24 h of the onset of stroke symptoms. The type of acute ischemic stroke was classified according to the Trial of Org 10172 in Acute Stroke Treatment classification. Blood samples were taken for measurement of brain natriuretic peptide levels at admission. Aortic stiffness indices, aortic strain and distensibility, were calculated from the aortic diameters measured by transthoracic echocardiography. The patients were followed for one-year or until death, whichever came first. Death occurred in 51 (16·5%) patients. On multivariate logistic regression analysis, National Institutes of Health Stroke Scale score >13, diabetes, brain natriuretic peptide >235 pg/mL, aortic distensibility, and aortic strain were associated with all-cause mortality. The optimal cutoff level of brain natriuretic peptide to distinguish the deceased group from the survival group was 235 pg/mL (sensitivity 71·0% and specificity 63·0%) and to distinguish cardioembolic stroke from noncardioembolic stroke was 155 pg/mL (sensitivity 81% and specificity 63%). Conclusions Aortic stiffness and brain natriuretic peptide predict mortality in patients with first-ever acute ischemic stroke. Brain natriuretic peptide also differentiates cardioembolic stroke from noncardioembolic stroke.
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Affiliation(s)
- Murat Biteker
- Department of Cardiology, Haydarpaşa Numune Education and Research Hospital, Istanbul, Turkey
| | - Temel Özden
- Department of 1st Neurology, Haydarpaşa Numune Education and Research Hospital, Istanbul, Turkey
| | - Akin Dayan
- Department of Family Medicine, Haydarpaşa Numune Education and Research Hospital, Istanbul, Turkey
| | - Ahmet Ilker Tekkeşin
- Department of Cardiology, Haydarpaşa Numune Education and Research Hospital, Istanbul, Turkey
| | - Cemile Handan Misirli
- Department of 1st Neurology, Haydarpaşa Numune Education and Research Hospital, Istanbul, Turkey
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Increased aortic stiffness can predict perioperative cardiovascular outcomes in patients undergoing noncardiac, nonvascular surgery. World J Surg 2012; 35:2411-6. [PMID: 21901323 DOI: 10.1007/s00268-011-1268-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Aortic stiffness is an early marker of arteriosclerosis and associated with cardiovascular mortality. However, the impact of aortic stiffness on perioperative cardiovascular outcomes in patients undergoing noncardiac surgery is unknown. METHODS The study population was composed of 660 consecutive adults aged 18 years and over (mean age = 65.3 ± 14 years) who underwent intermediate-risk (nonvascular), noncardiac surgery between January 2010 and February 2011. Nonemergency, non-day-case, open surgical procedures were enrolled. Aortic stiffness indices were calculated from the aortic diameters measured by echocardiography. Electrocardiography and cardiac biomarkers were evaluated 1 day before surgery, and on days 1, 3, and 7 after surgery. RESULTS Eighty patients (12.1%) experienced perioperative cardiovascular events (PCE). Preoperative aortic distensibility (AD) (2 ± 1.3 vs. 2.9 ± 1.1 cm2/dyn/10(3), P < 0.001) and aortic strain (AS) (4.4 ± 2.4 vs. 6.4 ± 1.9, P < 0.001) of the patients with PCE were significantly lower than in patients without PCE. Univariate analysis showed a significant association between age, diabetes mellitus (DM), coronary artery disease, preoperative atrial fibrillation, American Society of Anesthesiologists (ASA) status, Revised Cardiac Risk Index, left ventricle ejection fraction (LVEF), AD, aortic strain, and in-hospital PCE. However, on multivariate logistic regression analysis, only AD (OR: 1.94, 95% CI: 1.1-3.4; P = 0.02), AS (OR: 0.45, 95% CI: 0.3-0.6; P < 0.001), DM (OR: 2.28, 95% CI: 1.08-4.82; P = 0.03), and LVEF (OR: 0.96, 95% CI: 0.93-0.99; P = 0.03) remained as significant variables associated with PCE. CONCLUSION Impaired elastic properties of the aorta are associated with increased PCE rates in patients undergoing noncardiac, nonvascular surgery.
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Dogdu O, Kaya MG, Yarlioglues M, Dogan A, Ardic I, Elcik D, Kalay N, Kaynar L, Kurnaz F, Eryol NK. Impaired Aortic Elastic Properties in Patients with Chronic Graft-versus-Host Disease. Echocardiography 2011; 28:1011-8. [DOI: 10.1111/j.1540-8175.2011.01475.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Sozeri B, Mir S, Kara OD, Levent E. When does the cardiovascular disease appear in patients with chronic kidney disease? Pediatr Cardiol 2010; 31:821-8. [PMID: 20401476 DOI: 10.1007/s00246-010-9710-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2010] [Accepted: 04/01/2010] [Indexed: 10/19/2022]
Abstract
Cardiovascular disease is a leading cause of long-term morbidity and mortality among children with chronic kidney disease (CKD). At which stage of CKD these appear in children is unknown. This study aimed to determine the prevalence of cardiovascular disease in pediatric CKD patients and to explore the relationship of these changes and treatment methods. The study enrolled pediatric patients with stages 1-5 CKD including 20 patients receiving predialysis (PreD), 8 receiving peritoneal dialysis, and 14 receiving hemodialysis. Aortic stiffness, defined as decreased aortic strain (S) and increased pressure strain normalized by diastolic pressure (Ep*), was described. Sonography of the common carotid artery and left ventricle was performed. The mean age of the children was 13.3 + or - 5.3 years. The patients had lower S values (0.35 + or - 0.23) than the control subjects (0.44 + or - 0.2) (P < 0.05) but higher Ep* (2.46 + or - 1.31 vs. 1.32 + or - 0.09; P < 0.05). Aortic stiffness was found in 13 patients. The PreD group had lower As levels than the dialysis group but higher levels than the control group. The patients (n = 32) had greater carotid intima-media thickness than the control subjects (0.58 + or - 0.14 vs. 0.35 + or - 0.12; P < 0.05). The intima-media thickness was greatest in the PreD group (P < 0.05). The patients had a higher left ventricular mass index (LVMI; 42.4 + or - 15.6) than the control subjects (28.8 + or - 8.47) (P < 0.05) and a larger left ventricle end diastolic diameter (LVEDD; 3.44 + or - 0.76 vs. 2.59 + or - 0.34; P < 0.05). Left ventricular hypertrophy was found in 32 patients. Both LVMI and LVEDD were higher in the groups receiving hemodialysis and lower in the PreD group. Increased carotid-intima media thickness and left ventricle hypertrophy appeared without hypertension in the PreD group. The indications and timing of dialysis should be reevaluated for children with CKD. In the dialysis groups, fewer cardiovascular changes were found with peritoneal dialysis than with hemodialysis. Therefore, peritoneal dialysis should be preferable to hemodialysis for children with CKD.
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Affiliation(s)
- Betul Sozeri
- Department of Pediatric Nephrology, Faculty of Medicine, Ege University, Izmir, Turkey.
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Scherer S, Treichel T, Ritter N, Triebel G, Drossel WG, Burgert O. Surgical stent planning: simulation parameter study for models based on DICOM standards. Int J Comput Assist Radiol Surg 2010; 6:319-27. [DOI: 10.1007/s11548-010-0511-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Accepted: 06/19/2010] [Indexed: 11/28/2022]
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Ardic I, Kaya MG, Yarlioglues M, Karadag Z, Dogan A, Yildiz H, Dogdu O, Zencir C, Aktas E, Ergin A. Impaired aortic elastic properties in normotensive patients with psoriasis. Blood Press 2010; 19:351-8. [DOI: 10.3109/08037051.2010.505322] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Levent E, Atik T, Darcan S, Ulger Z, Gökşen D, Ozyürek AR. The relation of arterial stiffness with intrauterine growth retardation. Pediatr Int 2009; 51:807-11. [PMID: 19508453 DOI: 10.1111/j.1442-200x.2009.02905.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Much epidemiological evidence has linked low birthweight with late cardiovascular risk. Intrauterine growth retardation (IUGR) is associated with the increased risk of cardiovascular disease in adult life; it is unclear whether the relationship is present at younger ages. We evaluated whether abdominal aortic stiffness was altered in patients with IUGR (born at term with birthweight small for gestational age) in younger ages. METHODS Thirty-two (24 girls and eight boys) IUGR children aged 8.77 +/- 2.05 years were enrolled in the study. The birthweight was traced from the medical records. Their gestational ages were 38.9 +/- 0.85 weeks and birthweights 2130 +/- 198 g, respectively. Thirty-one healthy subjects who had normal gestational age and birthweight, matched for age and sex were recruited as a control group. Aortic strain, pressure strain elastic modulus (Ep), and normalized Ep and aortic distensibility were measured by a sphygmomanometer and transthoracic echocardiography in all subjects from the abdominal aorta. RESULTS There was no statistically significant difference between the study and the control groups in sex, mean age, body mass index, lipid profile, leptin, insulin-like growth factor-1 or insulin-like growth factor binding protein 3. In IUGR children, aortic strain (0.201 +/- 0.027 vs 0.254 +/- 0.031, P < 0.001) and aortic distensibility (1.08 +/- 0.19 vs 1.42 +/- 0.24, P < 0.001) were significantly lower compared with the control group. However Ep (188 +/- 36.2 vs 146 +/- 27.1, P < 0.001) and normalized Ep (2.97 +/- 0.40 vs 2.1 +/- 0.39, P < 0.001) were significantly higher in IUGR patients. CONCLUSIONS This study demonstrates that abdominal aortic stiffness is increased in IUGR patients. These data suggest that prenatal events could be related to cardiovascular risk in later life.
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Affiliation(s)
- Ertürk Levent
- Ege University, Faculty of Medicine, Department of Pediatric Cardiology, Izmir, Turkey
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Polat TB, Urganci N, Caliskan KC, Akyildiz B. Correlation of abdominal fat accumulation and stiffness of the abdominal aorta in obese children. J Pediatr Endocrinol Metab 2008; 21:1031-40. [PMID: 19189697 DOI: 10.1515/jpem.2008.21.11.1031] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM To evaluate abdominal adipose tissue accumulation in obese children by ultrasound measurement and compare with the elastic properties of the abdominal aorta. CHILDREN AND METHODS A total of 56 obese children and a control group of 30 non-obese children had an ultrasound examination for measurements of thickness of visceral, preperitoneal, and subcutaneous fat as well as abdominal aorta stiffness parameters. Anthropometric measurements and metabolic risk profile were assessed by physical examination and blood tests. RESULTS Abdominal aorta stiffness parameters were all significantly higher in the obese children than in the controls. Among the adipose tissue compartments, visceral fat thickness was the strongest correlate of abdominal aorta stiffness parameters. Similarly, the correlation between visceral abdominal adipose tissue and fasting insulin levels, HOMA score, and pulse pressure also approached significance. CONCLUSIONS This study suggests that abdominal adipose tissue accumulation is closely associated with cardiovascular risk factors in obese children, and among abdominal adipose tissue compartments, visceral fat thickness was strongly correlated with the elastic properties of the abdominal aorta.
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Affiliation(s)
- Tugcin Bora Polat
- Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Hospital, Turkey.
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18
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Tavil Y, Oztürk MA, Ureten K, Sen N, Kaya MG, Cemri M, Cengel A. Assessment of aortic wall stiffness in patients with Familial Mediterranean Fever. Joint Bone Spine 2008; 75:280-5. [PMID: 18375166 DOI: 10.1016/j.jbspin.2007.05.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2007] [Accepted: 05/30/2007] [Indexed: 10/22/2022]
Abstract
INTRODUCTION To evaluate aortic wall stiffness and its relation between the aortic stiffness and the left ventricular function in patients with Familial Mediterranean Fever (FMF). METHODS The study population was composed of 31 patients with FMF in attack-free period (12 men, 19 women; mean age: 36+/-7 years) and 27 healthy subjects (10 men, 17 women; mean age: 34+/-7 years) who had volunteered to participate. Aortic stiffness indices, aortic strain and distensibility, were calculated from the aortic diameters measured by echocardiography and blood pressure obtained by sphygmomanometry. RESULTS There were significant differences between the control and the patient group in aortic strain (mean (SD), 7.23+/-2.14 versus 4.91+/-1.66%, p=0.01) and distensibility (4.02+/-1.42 versus 2.84+/-1.46, 10(-6)cm(2)dyn(-1), p=0.001). Although there was no correlation between the aortic stiffness parameters and the left ventricular function parameters, there were significant negative correlations between the disease duration and aortic strain index (r=-0.29, p<0.001), and between the disease duration and distensibility (r=-0.32, p<0.001). CONCLUSION Aortic stiffness measurements were found abnormal in patients with FMF. We have also demonstrated that there were significant correlations between aortic stiffness parameters and disease duration.
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Affiliation(s)
- Yusuf Tavil
- Department of Cardiology, Gazi University School of Medicine, Beşevler 06500, Ankara, Turkey.
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Kim MJ, Lee SY, Kim YB, Kil HR. Clinical significance of the mechanical properties of the abdominal aorta in Kawasaki disease. KOREAN JOURNAL OF PEDIATRICS 2008. [DOI: 10.3345/kjp.2008.51.9.1012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Mi Jin Kim
- Department of Pediatrics, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Sang Yun Lee
- Department of Pediatrics, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Yong Bum Kim
- Department of Pediatrics, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Hong Ryang Kil
- Department of Pediatrics, College of Medicine, Chungnam National University, Daejeon, Korea
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Bakiler AR, Yavascan O, Harputluoglu N, Kara OD, Aksu N. Evaluation of aortic stiffness in children with chronic renal failure. Pediatr Nephrol 2007; 22:1911-9. [PMID: 17710441 DOI: 10.1007/s00467-007-0562-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2007] [Revised: 05/17/2007] [Accepted: 06/07/2007] [Indexed: 10/22/2022]
Abstract
The measurement of aortic stiffness (As) [aortic strain (S), pressure strain elastic modulus (Ep) and pressure strain normalized by diastolic pressure (Ep*)] is suggested as an excellent marker of subclinical arterial sclerosis. We aimed to investigate the presence of As and to determine the relationship between As and some risk factors in children with chronic renal failure (CRF). Twenty-six pre-dialysis (PreD) [female/male (F/M) 7/19] patients and 23 chronic peritoneal dialysis (CPD) (F/M 13/10) patients were assessed. Twenty-nine healthy children were selected as a control group (F/M 14/15). We determined anemia, abnormal calcium/phosphate metabolism, hypertension, diastolic dysfunction, increased left ventricular mass (LVM), hypertriglyceridemia, increased stiffness (Ep, Ep*), and decreased strain (S) in the CRF (PreD and CPD) group compared with the controls (P < 0.05). Presence of renal disease, LVM and usage of angiotensin-converting enzyme inhibitor (ACE-I) in all groups; female gender, duration of disease and the usage of anti-hypertensive drug therapy in CRF patients; and LVM and LVM index in healthy children were found to be independent predictors for aortic stiffness and/or strain. In conclusion, CRF is associated with significant arterial functional abnormalities in uremic children and not controlled by dialysis treatment. These results suggest that, even in young children, uremia has a profound impact on arterial function.
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Affiliation(s)
- Ali Rahmi Bakiler
- Department of Pediatric Cardiology, Tepecik Training and Research Hospital, Yenisehir, Izmir, Turkey
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21
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Abstract
Kawasaki disease (KD) is an acute self-limiting systemic vasculitis of unknown etiology and the most common cause of acquired coronary disease in children aged 6 months to 5 years. The inflammatory process results in coronary arteritis, aneurysmal lesions, arterial thrombotic occlusion or even sudden death. The diagnostic tests are unknown but treatment with immunoglobulin and aspirin is effective at reducing cardiac complications from 25 to 4.7% in the UK. Myocardial, endocardial or pericardial inflammation may occur acutely or many years later and abnormalities of myocardial blood flow may require ongoing medication, interventional catheterization or even cardiac surgery. There are several new drugs that may have important roles to play in managing KD in children and young adults.
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Affiliation(s)
- Louise Wood
- Bristol Royal Hospital for Children, Bristol Congenital Heart Centre, Bristol, UK.
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22
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Kim JH, Gil TY, Lee HW, Hong YM. Pulse wave velocity and ankle brachial index in normal adolescents. KOREAN JOURNAL OF PEDIATRICS 2007. [DOI: 10.3345/kjp.2007.50.6.549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Ji Hye Kim
- Department of Pediatrics, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Tae Young Gil
- Department of Pediatrics, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Hee Woo Lee
- Seoul School Health Promotion Center, Seoul, Korea
| | - Young Mi Hong
- Department of Pediatrics, School of Medicine, Ewha Womans University, Seoul, Korea
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Ulger Z, Aydinok Y, Gurses D, Levent E, Ozyurek AR. Stiffness of the abdominal aorta in beta-thalassemia major patients related with body iron load. J Pediatr Hematol Oncol 2006; 28:647-52. [PMID: 17023824 DOI: 10.1097/01.mph.0000212987.18694.5a] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Increased iron stores have been implicated in the association with increased risk of cardiovascular events. We evaluated whether the abdominal aortic stiffness was altered in the patients with beta-thalassemia major in relation with body iron load. METHODS Sixty-two (32 males and 30 females) beta-thalassemia major patients aged 16.47 +/- 4.8 years were enrolled into the study. Healthy 52 subjects matched for age and sex were recruited as controls. In all subjects, hemoglobin, fasting glucose, cholesterol, high-density lipoprotein-cholesterol, and low-density lipoprotein-cholesterol levels were measured. The average serum ferritin level and liver iron concentration (LIC) were assessed in thalassemia patients. Left ventricular function and mass were evaluated echocardiographically and aortic strain (S), pressure strain elastic modulus (Ep), and normalized Ep (Ep*), aortic distensibility (DIS), and beta stiffness index (beta index) were calculated in all subjects. RESULTS There was no statistically significant difference between the study and control groups in sex, mean age, body mass index, heart rate, and systolic blood pressure (P > 0.05). However, pulse pressure and left ventricular mass index (LVMI) were found higher in thalassemia major patients compared with the control group. In beta-thalassemia major patients S (0.21 +/- 0.027 vs. 0.26 +/- 0.017, P < 0.0001) and DIS (1.07 +/- 0.25 vs. 1.56 +/- 0.37, P < 0.0001) were significantly lower compared with the control group. However, Ep (196.9 +/- 44.86 vs. 134.20 +/- 29.10, P < 0.0001), Ep* (3.26 +/- 0.98 vs. 2.04 +/- 0.60, P < 0.0001), and beta index (2.44 +/- 0.58 vs. 1.61 +/- 0.37, P < 0.0001) were significantly higher in beta-thalassemia patients than controls. There was a statistically significant negative correlation between LIC and S, DIS. There was also negative correlation between LVMI and S. However, there was a statistically significant positive correlation between LIC and Ep, Ep*. CONCLUSIONS Increased abdominal aortic stiffness was detected in beta-thalassemia major patients and this increase in arterial stiffness correlated with LIC and LVMI.
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Affiliation(s)
- Zulal Ulger
- Department of Pediatric Cardiology, Ege University Hospital, Bornova-Izmir, Turkey.
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Peterson AL, Frommelt PC, Mussatto K. Presentation and echocardiographic markers of neonatal hypertensive cardiomyopathy. Pediatrics 2006; 118:e782-5. [PMID: 16880252 DOI: 10.1542/peds.2006-0631] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Systemic hypertension is a rare but important cause of neonatal heart failure. It is critical that this etiology be recognized and distinguished from other causes of myocardial dysfunction in young infants, because diagnostic studies, treatments, and prognoses are quite different. METHODS Between 1991 and 2005, 11 neonates were diagnosed as having neonatal cardiomyopathy and systemic hypertension through retrospective review of the Children's Hospital of Wisconsin database. RESULTS All infants in the cohort were found to have systemic hypertension (blood pressure of > 95th percentile for gestational age and weight). Causes included renovascular disease (n = 9), aortic obstruction secondary to thrombus (n = 1), and steroid use (n = 1). Echocardiography was performed at presentation for all patients because of cardiomegaly and/or hypertension. Echocardiographic findings were consistently striking for (1) left ventricular systolic dysfunction without chamber dilation, (2) concentric left ventricular hypertrophy, (3) left atrial dilation, and (4) aortomegaly. No anatomic aortic arch obstruction was identified, but Doppler findings for the descending thoracic aorta were uniformly consistent with elevated systemic vascular resistance. One patient died as a result of overwhelming thrombotic disease; all other patients responded to afterload reduction therapy with normalization of left ventricular systolic function during infancy. CONCLUSIONS Hypertensive cardiomyopathy can present in neonates with nonspecific symptoms and systemic hypertension. Because sometimes hypertension in infants is ignored or misinterpreted as agitation, echocardiography can provide critical markers of the disease.
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Affiliation(s)
- Amy L Peterson
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA
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25
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Joo SY, Cho KY, Cho SJ, Hong YM. Pulse wave velocity and ankle brachial index in adolescents with essential hypertension. KOREAN JOURNAL OF PEDIATRICS 2006. [DOI: 10.3345/kjp.2006.49.7.769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Sun Young Joo
- Department of Pediatrics, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Ki Young Cho
- Department of Pediatrics, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Su Jin Cho
- Department of Pediatrics, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Young Mi Hong
- Department of Pediatrics, College of Medicine, Ewha Womans University, Seoul, Korea
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Yasuoka K, Harada K. Wall motion velocities of abdominal aorta measured by tissue Doppler imaging in normal children. Pediatr Cardiol 2005; 26:323-7. [PMID: 16374679 DOI: 10.1007/s00246-004-0476-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Tissue Doppler imaging (TDI) offers a new technique for assessing aortic wall expansion/contraction velocities and may provide a noninvasive approach to aortic wall mechanics. The purpose of this study was to determine the normal values of abdominal aortic wall motion velocities and the effect of age on these velocities in normal children. We examined 103 normal children. Using TDI, maximum wall expansion velocity during systole (peak S) and maximum wall contraction velocity during diastole (peak D) were measured. M-mode diameter of the abdominal aorta and systolic, diastolic, and mean arterial pressures were measured. Aortic stiffness was measured as (I(n)[BP(syst)/BP(diast)])/(D(s)-D(d)/D(d), where I(n) is the natural log, D(s) is the maximal abdominal aortic diameter during systole, and D(d) is the abdominal aortic diameter at end-diastole. In all subjects, wall motion velocities of the abdominal aorta were recorded. The mean values for peak S and peak D were 4.23, 1.14 and 2.16, 0.45 cm/sec, respectively. Both peak S and peak D were low in infants and increased significantly with age (r = 0.63, p < 0.0001 and r = 0.36, p = 0.0002, respectively), systolic blood pressure (r = 0.42 and 0.47, respectively, p < 0.0001), and diastolic blood pressure (r = 0.24, p = 0.016 and r = 0.28, p = 0.0038, respectively). Aortic stiffness index of the abdominal aorta was constant with age and did not correlate with peak S or peak D. Abdominal aortic wall motion velocities can be easily assessed by TDI. Age-related changes in the aortic wall motion velocities are observed in normal children. This study provides baseline information for further quantitative assessment of arterial stiffness in children with congenital or acquired heart disease.
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Affiliation(s)
- K Yasuoka
- Department of Pediatrics, Akita University School of Medicine, 1-1-1 Hondo, Japan.
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Harada K, Yasuoka K, Shimada Y. Usefulness of tissue doppler imaging for assessing aortic wall stiffness in children with the Marfan syndrome. Am J Cardiol 2004; 93:1072-5. [PMID: 15081464 DOI: 10.1016/j.amjcard.2003.12.067] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2003] [Revised: 12/26/2003] [Accepted: 12/26/2003] [Indexed: 10/26/2022]
Abstract
The purpose of this study was to assess wall motion velocities of the abdominal aorta using tissue Doppler imaging (TDI) in 12 patients with Marfan syndrome and 30 age-matched normal controls. The patients with Marfan syndrome displayed an increased aortic stiffness index in the abdominal aorta, and significant relationships were observed between wall motion velocities of the abdominal aorta and the aortic stiffness index. Thus, TDI analyzes aortic expansion and contraction velocities and allows the identification of abdominal aortic stiffness in patients with Marfan syndrome.
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Affiliation(s)
- Kenji Harada
- Department of Pediatrics and the Department of Orthopedic Surgery, Akita University School of Medicine, 1-1-1 Hondo, Akita, Japan.
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Levent E, Gökşen D, Ozyürek AR, Darcan S, Mahmut C, Coker M, Güven H, Parlar A. Stiffness of the abdominal aorta in obese children. J Pediatr Endocrinol Metab 2002; 15:405-9. [PMID: 12008687 DOI: 10.1515/jpem.2002.15.4.405] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Obesity is pathogenically related to clinical and subclinical disorders that contribute to the development of atherosclerotic plaques and their complications leading to onset of cardiovascular events. Arterial stiffness may be an indicator of early vascular changes signaling the development of vascular disease. The purpose of this study was to assess the stiffness of the abdominal aorta using transthoracic echocardiography in normotensive obese and hypertensive obese pediatric patients and a control group. The study group consisted of 25 healthy children (M/F: 13/12) as a control group (Group I), 25 normotensive obese children (M/F: 13/12) (Group II) and 25 hypertensive obese children (M/F: 14/11) (Group III). The mean ages were 12.1 +/- 1.8, 11.9 +/- 1.5 and 12.4 +/- 1.4 years, respectively. Aortic strain (S), pressure strain elastic modulus (Ep) and normalized Ep (Ep*) measurements were significantly different in the hypertensive obese group, and cholesterol levels and body mass index were higher in this group. These findings may be important in determining the relationship between obesity and cardiovascular risk factors at pediatric age.
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Affiliation(s)
- Ertürk Levent
- Department of Pediatric Cardiology, Faculty of Medicine, Ege University, Bornova, Izmir, Turkey.
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