Early ventricular contraction in children with primary hypertension relates to left ventricular mass

Association Between First-Phase Left Ventricular Ejection Fraction and Severity of Coronary Artery Stenosis and Changes With Interventional Treatment

BACKGROUND

Myocardial ischemia can impair the speed and intensity of myocardial contractility, frequently undetectable by conventional echocardiography in early stages. The aim of this study was to assess whether first-phase left ventricular ejection fraction (LVEF-1), a sensitive myocardial contractility marker, correlates with ischemia severity and improves following interventional treatment.

METHODS AND RESULTS

Two hundred seven patients were categorized into mild, moderate, and severe groups based on angiographic coronary maximal stenosis. LVEF-1, Gensini scores, and clinical data were compared among these groups. Logistic regression was used to assess the association between LVEF-1 and coronary artery stenosis, and linear regression identified factors linked to postintervention LVEF-1 improvement. The median LVEF-1 in the 3 groups was 29.6% (28.2-31.7), 27.8% (27.0-28.6), and 25.2% (23.6-26.5) (P<0.001). LVEF-1 showed inverse correlation with Gensini score (r=-0.694, P<0.001) and BNP (B-type natriuretic peptide; r=-0.244, P<0.001). LVEF-1 was independently associated with coronary artery stenosis ≥50% or ≥70%. A cutoff value of 26.9% for LVEF-1 had a sensitivity of 89.5% and specificity of 83.9% for predicting coronary artery stenosis ≥70%. Following intervention, LVEF-1 increased from 24.70% (23.30-26.32) to 28.10% (26.80-29.92) in 82 patients. Stent diameter was identified as an independent factor associated with improvement in LVEF-1 post intervention.

CONCLUSIONS

LVEF-1 is negatively correlated with the severity of coronary artery stenosis, and it improves significantly after coronary artery intervention therapy, suggesting that LVEF-1 can serve as a novel indicator for assessing coronary artery stenosis severity and monitoring the efficacy of interventional treatment.

Decline in Left Ventricular Early Systolic Function with Worsening Kidney Function in Children with Chronic Kidney Disease: Insights from the 4C and HOT-KID Studies

INTRODUCTION

Adults with childhood-onset chronic kidney disease (CKD) have an increased risk of cardiovascular disease. First-phase ejection fraction (EF1), a novel measure of early systolic function, may be a more sensitive marker of left ventricular dysfunction than other markers in children with CKD.

OBJECTIVE

To examine whether EF1 is reduced in children with CKD.

METHODS

Children from the 4C and HOT-KID studies were stratified according to estimated glomerular filtration rate (eGFR). The EF1 was calculated from the fraction of left ventricular (LV) volume ejected up to the time of peak aortic flow velocity.

RESULTS

The EF1 was measured in children ages 10.9 ± 3.7 (mean ± SD) years, 312 with CKD and 63 healthy controls. The EF1 was lower, while overall ejection fraction was similar, in those with CKD compared with controls and decreased across stages of CKD (29.3% ± 3.7%, 23.5% ± 4.5%, 19.8% ± 4.0%, 18.5% ± 5.1%, and 16.7% ± 6.6% in controls, CKD 1, 2, 3, and ≥ 4, respectively, P < .001). The relationship of EF1 to eGFR persisted after adjustment for relevant confounders (P < .001). The effect size for association of measures of LV structure or function with eGFR (SD change per unit change in eGFR) was greater for EF1 (β = 0.365, P < .001) than for other measures: LV mass index (β = -0.311), relative wall thickness (β = -0.223), E/e' (β = -0.147), and e' (β = 0.141) after adjustment for confounders in children with CKD.

CONCLUSIONS

Children with CKD exhibit a marked and progressive decline in EF1 with falling eGFR. This suggests that EF1 is a more sensitive marker of LV dysfunction when compared to other structural or functional measures and that early LV systolic function is a key feature in the pathophysiology of cardiac dysfunction in CKD.

Systolic and diastolic left ventricular function in children with primary hypertension: a systematic review and meta-analysis

OBJECTIVE

Evaluation of left ventricular function provides early evidence of target-organ damage in children with primary hypertension. We performed a systematic review and meta-analysis of left ventricular systolic and diastolic function in children and adolescents with primary hypertension.

METHODS

Literature search was performed in PubMed database and out of 718 articles (published between 2000 and 2021) 22 studies providing comparison of left ventricular function parameters between children with primary hypertension and normotensive controls were selected.

RESULTS

Overall, 3460 children (5-21 years) with primary hypertension were analyzed. Meta-analysis showed that hypertensive patients when compared with normotensives, had an increased heart rate (mean difference [MD] 5.59; 95% confidence interval [CI] 3.28, 7.89; 10 studies) and increased fractional shortening (MD 1.04; 95% CI 0.48, 1.60; 9 studies) but did not differ in ejection fraction (MD -0.03; 95% CI -1.07, 1.02; 12 studies). Stroke volume was higher in one out of three studies, whereas no differences in cardiac output were found in two studies with available data. Hypertensive children had also lower E/A values (MD -0.21; -0.33, -0.09; 14 studies), greater values of E/e' (MD 0.59; 0.36, 0.82; 8 studies) and greater global longitudinal stress (MD 2.50; 2.03, 2.96; 4 studies) when compared to those with normotension.

CONCLUSION

Our results indicate that hypertensive children and adolescents present with signs of hyperkinetic function of the left ventricle, demonstrate evidence of increased left ventricular strain and impaired diastolic function compared to normotensive controls.

Hypertension in Children and Young Adults

Primary hypertension (PH) is most common during adolescence with increasing prevalence globally, alongside the epidemic of obesity. Unlike in adults, there are no data on children with uncontrolled hypertension and their future risk of hard cardiovascular and cerebrovascular outcomes. However, hypertension in childhood is linked to hypertensive-mediated organ damage (HMOD) which is often reversible if treated appropriately. Despite differing guidelines regarding the threshold for defining hypertension, there is consensus that early recognition and prompt management with lifestyle modification escalating to antihypertensive medication is required to ameliorate adverse outcomes. Unfortunately, many unknowns remain regarding pathophysiology and optimum treatment of childhood hypertension.

Different Associations of Systolic Blood Pressure and Body Mass Index With Cardiac Structure and Function in Young Children

Background:

Both elevated systolic blood pressure (SBP) and excess weight can lead to early cardiovascular organ damage in children. In this study, we investigated whether there is a difference in the associations of SBP and body mass index (BMI) with cardiovascular structure and function in 4-year-old children.

Methods:

In 1474 children (52.3% males) from the Shanghai Birth Cohort, physical examination and echocardiography were performed. Standardized linear regression models were used to evaluate the associations of BMI Z score and SBP Z score with cardiovascular parameters and to compare the strengths of these associations.

Results:

The incidence of SBP elevation significantly increased in overweight children. SBP was positively related to heart rate, left ventricular (LV) ejection fraction and fraction shortening (β=1.824 [95% CI, 1.014–2.634], 0.579 [0.294–0.864], and 0.480 [0.257–0.704], respectively). BMI Z score was positively associated with LV mass index (β=1.225 [0.863–1.587]) and the risk of LV hypertrophy (odds ratio=1.428 [1.157–1.761]) but negatively related to measures of systolic function, including LV ejection fraction, LV fraction short, and global longitudinal strain (β=−0.417 [−0.735 to −0.099], −0.302 [−0.551 to −0.053], and −0.392 [−0.621 to −0.163], respectively). No noteworthy additive or multiplicative interactions between BMI and SBP were detected.

Conclusions:

Elevations in both BMI and SBP were related to cardiac structure and function in children as young as 4 years old. Elevated SBP was associated with increased heart rate and LV ejection at the early stage of BP elevation. BMI showed a closer relationship with left heart diameters and geometry than SBP.

Prevalence of left ventricular hypertrophy in children and young people with primary hypertension: Meta-analysis and meta-regression

BACKGROUND

Left ventricular hypertrophy (LVH) is the main marker of HMOD in children and young people (CYP). We aimed to assess the prevalence of LVH and its determinants in CYP with primary hypertension (PH).

METHODS

A meta-analysis of prevalence was performed. A literature search of articles reporting LVH in CYP with PH was conducted in Medline, Embase, and Cochrane databases. Studies with a primary focus on CYP (up to 21 years) with PH were included. Meta-regression was used to analyze factors explaining observed heterogeneity.

RESULTS

The search yielded a total of 2,200 articles, 153 of those underwent full-text review, and 47 reports were included. The reports evaluated 51 study cohorts including 5,622 individuals, 73% male subjects, and a mean age of 13.6 years. LVH was defined as left ventricle mass index (LVMI) ≥ 95th percentile in 22 (47%), fixed cut-off ≥38.6 g/m2.7 in eight (17%), sex-specific fixed cut-off values in six (13%), and miscellaneously in others. The overall prevalence of LVH was 30.5% (95% CI 27.2-33.9), while heterogeneity was high (I 2 = 84%). Subgroup analysis including 1,393 individuals (76% male subjects, mean age 14.7 years) from pediatric hypertension specialty clinics and LVH defined as LVMI ≥95th percentile only (19 study cohorts from 18 studies), reported prevalence of LVH at 29.9% (95% CI 23.9 to 36.3), and high heterogeneity (I 2 = 84%). Two studies involving patients identified through community screening (n = 1,234) reported lower LVH prevalence (21.5%). In the meta-regression, only body mass index (BMI) z-score was significantly associated with LVH prevalence (estimate 0.23, 95% CI 0.08-0.39, p = 0.004) and accounted for 41% of observed heterogeneity, but not age, male percentage, BMI, or waist circumference z-score. The predominant LVH phenotype was eccentric LVH in patients from specialty clinics (prevalence of 22% in seven studies with 779 participants) and one community screening study reported the predominance of concentric LVH (12%).

CONCLUSION

Left ventricular hypertrophy is evident in at least one-fifth of children and young adults with PH and in nearly a third of those referred to specialty clinics with a predominant eccentric LVH pattern in the latter. Increased BMI is the most significant risk association for LVH in hypertensive youth.

Diastolic Function and Ambulatory Hypertension in Children With Chronic Kidney Disease

[Figure: see text].