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Godoy-Leite M, Santos FGCD, Penido EAR, Ribeiro KA, Dos Santos LM, Rodrigues-Machado MDG, Rezende BA. Impact of social isolation during COVID-19 on anthropometric data, quality of life, baseline physical activity and aortic pulse wave parameters in children and adolescents in two independent samples. Ital J Pediatr 2023; 49:154. [PMID: 37981678 PMCID: PMC10659065 DOI: 10.1186/s13052-023-01558-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/05/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND The social restrictions resulting from the COVID-19 pandemic had a great impact on the routine of children and adolescents, with important consequences such as sleep, eating, and psychological/psychiatric disorders. Even though there are no studies on the subject, it is possible that these changes in habit and routine have also affected arterial stiffness (AS) in this population, which is an important predictor of cardiovascular risk. This study aimed to assess possible changes in AS, anthropometry, and quality of life (QoL) resulting from the COVID-19 pandemic in children and adolescents. METHODS A controlled observational cross-sectional study was performed with 193 children and adolescents aged 9 to 19 years, allocated into two groups: before the pandemic (BPG) and one year after the pandemic (APG), matched by age and sex. Cardiovascular parameters were measured non-invasively by brachial artery oscillometry with a portable device. The main AS indices evaluated were the augmentation index (AIx) and pulse wave velocity (PWV) derived from the aortic pulse wave. QoL was assessed using the Paediatric Quality of Life Inventory version 4.0 (PedsQL 4.0). RESULTS Regarding QoL, the APG showed a worsening in emotional (p = 0.002) and school-related (p = 0.010) aspects. There was no statistically significant difference for most anthropometric parameters, except for the hip circumference, which was higher in the APG group (p < 0.001). The main predictor of AS in the paediatric population, AIx@75, was shown to be increased in the APG group (p < 0.001). Other cardiovascular parameters were also different, such as peripheral (p = 0.002) and central (p = 0.003) diastolic blood pressure, stroke volume (p = 0.010), and total vascular resistance (p = 0.002), which were shown to be decreased in the APG group, while the heart rate was increased (p < 0.001). CONCLUSIONS Our results show that routine changes resulting from the period of social isolation increased cardiovascular risk in children and adolescents, evident by the increase in AIx@75, which is considered to be an important marker of cardiovascular risk in the paediatric population.
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Affiliation(s)
- Mariana Godoy-Leite
- School of Medical Sciences of Minas Gerais, 275, Alameda Ezequiel Dias, Belo Horizonte, 30130-110, Brazil
| | | | | | - Kennad Alves Ribeiro
- School of Medical Sciences of Minas Gerais, 275, Alameda Ezequiel Dias, Belo Horizonte, 30130-110, Brazil
| | - Luzia Maria Dos Santos
- School of Medical Sciences of Minas Gerais, 275, Alameda Ezequiel Dias, Belo Horizonte, 30130-110, Brazil
| | | | - Bruno Almeida Rezende
- School of Medical Sciences of Minas Gerais, 275, Alameda Ezequiel Dias, Belo Horizonte, 30130-110, Brazil.
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Brar PC. Can Surrogate Markers Help Define Cardiovascular Disease in Youth? Curr Atheroscler Rep 2023:10.1007/s11883-023-01101-6. [PMID: 37148462 DOI: 10.1007/s11883-023-01101-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2023] [Indexed: 05/08/2023]
Abstract
PURPOSE OF REVIEW Non-invasive measurements such as arterial stiffness serve as proxy surrogates for detection of early atherosclerosis and ASCVD risk stratification. These surrogate measurements are influenced by age, gender, and ethnicity and affected by the physiological changes of puberty and somatic growth in children and adolescents. RECENT FINDINGS There is no consensus of the ideal method to measure surrogate markers in youth (< 18 years of age), nor standardized imaging protocols for youth. Currently, pediatric normative data are available but not generalizable. In this review, we provide rationale on how currently used surrogates can help identify subclinical atherosclerosis in youth and affirm their role in identifying youth at risk for premature CVD.
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Hanssen H. Vascular biomarkers in the prevention of childhood cardiovascular risk: From concept to clinical implementation. Front Cardiovasc Med 2022; 9:935810. [PMID: 36072878 PMCID: PMC9441864 DOI: 10.3389/fcvm.2022.935810] [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] [Received: 05/04/2022] [Accepted: 08/02/2022] [Indexed: 02/01/2023] Open
Abstract
Vascular biomarkers allow for non-invasive assessment of vascular structure and function and have been shown to be surrogates for cardiovascular (CV) outcome in adults. They reflect the cumulative risk of a plethora of single CV risk factors, such as obesity and hypertension, on the arterial wall. The process of atherosclerosis oftentimes has its origin in childhood and tracks into adulthood. Obesity-related CV risk in childhood is a main determinant of manifest CV disease and adverse outcome in adulthood. To date, prevention strategies are directed toward the detection and reduction of CV disease in adulthood. This review updates and puts into perspective the potential use of vascular biomarkers in children. With reference to the concept of early vascular aging in adults, it elaborates on the role of vascular biomarkers for CV risk stratification in children. The concept of primordial vascular aging implies that young children be screened for vascular health, in an attempt to timely detect subclinical atherosclerosis and initiate treatment strategies to reverse vascular damage in a period of life with high probability for risk regression. The evidence for the validity of macro- and microvascular candidate biomarkers as screening tools of CV risk in children is reviewed, and limitations as well as remaining research gaps are highlighted. Furthermore, an overview on the effects of exercise treatment on vascular biomarkers is given. Vascular biomarkers susceptible to lifestyle or drug treatment have the potential to qualify as monitoring tools to guide clinicians. This review discusses evidence for vascular biomarkers to optimize screening of childhood CV risk from initial concepts to potential future clinical implementation in cardiovascular prevention.
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Bradley TJ. Does Routine Measurement of Aortic Stiffness in Children with Bicuspid Aortic Valve Provide an Opportunity to Better Personalize Care? Can J Cardiol 2022; 38:557-559. [DOI: 10.1016/j.cjca.2022.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 03/21/2022] [Accepted: 03/21/2022] [Indexed: 11/02/2022] Open
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Rossi-Monteiro EM, Sefair LR, Lima MC, Nascimento MFL, Mendes-Pinto D, Anschuetz L, Rodrigues-Machado MG. Pediatric obstructive sleep-disordered breathing is associated with arterial stiffness. Eur J Pediatr 2022; 181:725-734. [PMID: 34557975 DOI: 10.1007/s00431-021-04238-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/06/2021] [Accepted: 08/10/2021] [Indexed: 01/14/2023]
Abstract
The association between obstructive sleep-disordered breathing (oSDB) and arterial stiffness, an independent predictor of cardiovascular outcomes, is not well established in children. This study compared cardiovascular parameters between healthy and oSDB children and aimed to identify predictors of arterial stiffness indices in children with oSDB. Cross-sectional study realized in a tertiary hospital from June 2018 to January 2020. Forty-eight children (3 to 10 years old) with clinical diagnosis of oSDB and indication for adenotonsillectomy and 24 controls were evaluated. Cardiovascular parameters were measured non-invasively by brachial artery oscillometry with a portable device. The main arterial stiffness indices assessed were augmentation index and pulse wave velocity, both derived from the aortic pulse wave. In the oSDB group, the questionnaires Obstructive Sleep Apnea-18 (OSA-18) and Pediatric Quality of Life Inventory version 4.0 (PedsQL 4.0) were applied. The oSDB group had higher values of reflection coefficient (p = 0.044) and augmentation index (p = 0.003) than the control group. Stepwise multiple regression analysis revealed that age, female sex, reflection coefficient, and systolic volume were independent predictors of augmentation index. Higher pulse wave velocity values were associated with worse quality of life assessed by PedsQL 4.0 questionnaire. There was no association with OSA-18. The vascular and hemodynamic parameters were similar in both groups.Conclusion: Children with oSDB have increased augmentation index, an independent predictor of cardiovascular outcomes. The early identification of subclinical cardiovascular changes reinforces the importance of treating the disease, as well as changing lifestyle habits, to prevent complications in adulthood. What is Known: • The association between oSDB and cardiovascular risk in adults is well described in the literature. • Children with oSDB, regardless of their weight or sex, have higher PWV values when compared to non-snoring children. What is New: • Children with oSDB have augmented arterial stiffness, evidenced by the increase in AIx@75, measured non-invasively by brachial artery oscillometry with a portable device. • Low quality of life and therefore a high disease burden in children with oSDB may be a risk factor for arterial stiffness.
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Affiliation(s)
- Eduardo Machado Rossi-Monteiro
- Post-Graduate Program in Health Sciences, Faculdade Ciências Médicas de Minas Gerais - FCM-MG, MG, Belo Horizonte, Brazil.,Department of Otorhinolaryngology, Hospital Felício Rocho, Belo Horizonte, MG, Brazil
| | | | - Marcos Correia Lima
- Department of Otorhinolaryngology, Hospital Felício Rocho, Belo Horizonte, MG, Brazil
| | | | - Daniel Mendes-Pinto
- Department of Vascular Surgery, Hospital Felício Rocho, Belo Horizonte, MG, Brazil
| | - Lukas Anschuetz
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Maria Glória Rodrigues-Machado
- Post-Graduate Program in Health Sciences, Faculdade Ciências Médicas de Minas Gerais - FCM-MG, MG, Belo Horizonte, Brazil.
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Regional Vascular Changes and Aortic Dilatation in Pediatric Patients with Bicuspid Aortic Valve. Can J Cardiol 2022; 38:688-694. [DOI: 10.1016/j.cjca.2022.01.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/04/2022] [Accepted: 01/18/2022] [Indexed: 12/31/2022] Open
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Fong TS, Urbina EM, Howden EJ, Wallace I, Park C, Gall S, Salim A, Boutouyrie P, Bruno RM, Climie RE. Youth Vascular Consortium (YVC) Protocol: Establishing Reference Intervals for Vascular Ageing in Children, Adolescents and Young Adults. Heart Lung Circ 2021; 30:1710-1715. [PMID: 34274229 DOI: 10.1016/j.hlc.2021.05.107] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/16/2021] [Accepted: 05/25/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND In the last two decades, the global prevalence of paediatric hypertension increased by approximately 75%. Nearly 25% of children are now classified as obese or overweight. Substantial evidence suggests that risk factors for cardiovascular disease (CVD) begin to develop in childhood, thus warranting the need for tools to better screen for early CVD risk in youth. Vascular ageing, the deterioration of vascular structure and function, may be a potentially useful tool for detecting the early and asymptomatic signs of CVD burden. However, it is currently unclear what differentiates normal from pathological ageing in youth as existing reference values for vascular ageing in youth are limited by small sample size or homogenous populations. The international Youth Vascular Consortium (YVC) has been established to address these issues. AIMS The primary aim of the YVC is to develop reference intervals of normal vascular ageing in children, adolescents, and young adults. The secondary, exploratory, aim is to perform head-to-head comparisons of vascular ageing biomarkers to determine which biomarker is most strongly related to cardiometabolic health. STUDY DESIGN The YVC is a retrospective, multicentre study and will collate data on vascular ageing in children (5-12 years), adolescents (13-18 years) and young adults (19-40 years), as well as routine clinical biochemistry, lifestyle, sociodemographic factors and parental health. CONCLUSION To date, 31 research groups from 19 countries have joined the YVC. To our knowledge, this will be the largest study of its kind to investigate vascular ageing in youth.
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Affiliation(s)
- Terence S Fong
- Sports Cardiology Lab, Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Vic, Australia; Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, Vic, Australia
| | - Elaine M Urbina
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Erin J Howden
- Sports Cardiology Lab, Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Vic, Australia; Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, Vic, Australia
| | - Imogen Wallace
- Sports Cardiology Lab, Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Vic, Australia
| | - Chloe Park
- Department of Population Science & Experimental Medicine, Institute of Cardiovascular Science, University College London, London, UK; MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK
| | - Seana Gall
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tas, Australia
| | - Agus Salim
- Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, Vic, Australia; Department of Population Health, Baker Heart and Diabetes Institute, Melbourne, Vic, Australia; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Vic, Australia
| | - Pierre Boutouyrie
- Pharmacology Unit, Hôpital Européen Georges Pompidou, Université Paris Descartes, Paris, France; Université de Paris, INSERM, U970, Paris Cardiovascular Research Center (PARCC), Paris, France
| | - Rosa-Maria Bruno
- Pharmacology Unit, Hôpital Européen Georges Pompidou, Université Paris Descartes, Paris, France; Université de Paris, INSERM, U970, Paris Cardiovascular Research Center (PARCC), Paris, France
| | - Rachel E Climie
- Sports Cardiology Lab, Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Vic, Australia; Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, Vic, Australia; Menzies Institute for Medical Research, University of Tasmania, Hobart, Tas, Australia; Université de Paris, INSERM, U970, Paris Cardiovascular Research Center (PARCC), Paris, France.
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Plante V, Gobeil L, Xiong WT, Touré M, Dahdah N, Greenway SC, Drolet C, Wong KK, Mackie AS, Bradley TJ, Mertens L, Cavallé-Garrido T, Penslar J, Wong D, Dallaire F. Alternative to body surface area as a solution to correct systematic bias in pediatric echocardiography Z scores. Can J Cardiol 2021; 37:1790-1797. [PMID: 34216742 DOI: 10.1016/j.cjca.2021.06.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/19/2021] [Accepted: 06/24/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Z scores are the method of choice to report dimensions in pediatric echocardiography. Z scores based on body surface area (BSA) have been shown to cause systematic biases in overweight and obese children. Using aortic valve (AoV) diameters as a paradigm, the aims of this study were to assess the magnitude of Z score underestimation in children with increased body mass index Z score (BMI-Z) and to determine if a predicting model with height and weight as independent predictors would minimize this bias. METHODS In this multicenter, retrospective, cross-sectional study, 15,006 normal echocardiograms in healthy children 1-18 years old were analyzed. Residual associations with body size were assessed for previously published Z score. BSA-based and alternative prediction models based on height and weight were developed and validated in separate training and validation samples. RESULTS Existing BSA-based Z scores incompletely adjusted for weight, BSA and BMI-Z and led to an underestimation of >0.8 Z score units in subjects with higher BMI-Z, compared to lean subjects. BSA-based models led to overestimation of predicted AoV diameters with increasing weight or BMI-Z. Models using height and weight as independent predictors improved adjustment with body size, including in children with higher BMI-Z. CONCLUSIONS BSA-based models result in underestimation of Z scores in patients with high BMI-Z. Prediction models using height and weight as independent predictors minimize residual associations with body size and generate well-fitted predicted values that could apply to all children, including those with low or high BMI-Z.
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Affiliation(s)
- Virginie Plante
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Laurence Gobeil
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Wei Ting Xiong
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Moustapha Touré
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Nagib Dahdah
- Division of Pediatric Cardiology, Sainte-Justine University Hospital, Université de Montréal, Montreal, QC, Canada
| | - Steven C Greenway
- Departments of Pediatrics, Cardiac Sciences and Biochemistry & Molecular Biology, Alberta Children's Hospital Research Institute and Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Christian Drolet
- Centre Hospitalier de l'Université Laval, Centre Hospitalier Universitaire de Québec, Université Laval, Quebec City, QC, Canada
| | - Kenny K Wong
- IWK Health Center, Dalhousie University, Halifax, NS, Canada
| | - Andrew S Mackie
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Timothy J Bradley
- Division of Cardiology, Department of Pediatrics, University of Saskatchewan, Saskatoon, SK, Canada
| | - Luc Mertens
- Division of Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Tiscar Cavallé-Garrido
- Division of Cardiology, Department of Pediatrics, McGill University, Montreal, QC, Canada
| | - Joshua Penslar
- Division of Cardiology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Derek Wong
- Division of Cardiology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Frédéric Dallaire
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, QC, Canada.
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