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Mertens L, Singh G, Armenian S, Chen MH, Dorfman AL, Garg R, Husain N, Joshi V, Leger KJ, Lipshultz SE, Lopez-Mattei J, Narayan HK, Parthiban A, Pignatelli RH, Toro-Salazar O, Wasserman M, Wheatley J. Multimodality Imaging for Cardiac Surveillance of Cancer Treatment in Children: Recommendations From the American Society of Echocardiography. J Am Soc Echocardiogr 2023; 36:1227-1253. [PMID: 38043984 DOI: 10.1016/j.echo.2023.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Affiliation(s)
- Luc Mertens
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Gautam Singh
- Children's Hospital of Michigan, Detroit, Michigan; Central Michigan University School of Medicine, Saginaw, Michigan
| | - Saro Armenian
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - Ming-Hui Chen
- Boston Children's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Adam L Dorfman
- University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, Michigan
| | - Ruchira Garg
- Cedars-Sinai Heart Institute, Los Angeles, California
| | | | - Vijaya Joshi
- St. Jude Children's Research Hospital/University of Tennessee College of Medicine, Memphis, Tennessee
| | - Kasey J Leger
- University of Washington, Seattle Children's Hospital, Seattle, Washington
| | - Steven E Lipshultz
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Oishei Children's Hospital, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | | | - Hari K Narayan
- University of California San Diego, Rady Children's Hospital San Diego, San Diego, California
| | - Anitha Parthiban
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | | | - Olga Toro-Salazar
- Connecticut Children's Medical Center, University of Connecticut School of Medicine, Hartford, Connecticut
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2
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Grabitz C, Sprung KM, Amagliani L, Memaran N, Schmidt BMW, Tegtbur U, von der Born J, Kerling A, Melk A. Cardiovascular health and potential cardiovascular risk factors in young athletes. Front Cardiovasc Med 2023; 10:1081675. [PMID: 37332595 PMCID: PMC10272594 DOI: 10.3389/fcvm.2023.1081675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 03/27/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction Cardiovascular disease remains the most common cause of death worldwide, and early manifestations are increasingly identified in childhood and adolescence. With physical inactivity being the most prevalent modifiable risk factor, the risk for cardiovascular disease is deemed low in people engaging in regular physical exercise. The aim of this study was to investigate early markers and drivers of cardiovascular disease in young athletes pursuing a career in competitive sports. Methods One hundred and five athletes (65 males, mean age 15.7 ± 3.7 years) were characterized by measurement of body impedance to estimate body fat, blood pressure (BP), carotid femoral pulse wave velocity (PWV) to evaluate arterial elasticity, ergometry to assess peak power output, echocardiography to calculate left ventricular mass, and blood tests. Results Systolic BP was elevated in 12.6% and thereby more than twice as high as expected for the normal population. Similarly, structural vascular and cardiac changes represented by elevated PWV and left ventricular mass were found in 9.5% and 10.3%. Higher PWV was independently associated with higher systolic BP (β = 0.0186, p < 0.0001), which in turn was closely correlated to hemoglobin levels (β = 0.1252, p = 0.0435). In this population, increased left ventricular mass was associated with lower resting heart rate (β = -0.5187, p = 0.0052), higher metabolic equivalent hours (β = 0.1303, p = 0.0002), sport disciplines with high dynamic component (β = 17.45, p = 0.0009), and also higher systolic BP (β = 0.4715, p = 0.0354). Conclusion Despite regular physical exercise and in the absence of obesity, we found an unexpected high rate of cardiovascular risk factors. The association of PWV, systolic BP, and hemoglobin suggested a possible link between training-induced raised hemoglobin levels and altered vascular properties. Our results point toward the need for thorough medical examinations in this seemingly healthy cohort of children and young adults. Long-term follow-up of individuals who started excessive physical exercise at a young age seems warranted to further explore the potential adverse effects on vascular health.
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Affiliation(s)
- Carl Grabitz
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Katharina M. Sprung
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Laura Amagliani
- Institute of Sports Medicine, Hannover Medical School, Hannover, Germany
| | - Nima Memaran
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | | | - Uwe Tegtbur
- Institute of Sports Medicine, Hannover Medical School, Hannover, Germany
| | - Jeannine von der Born
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Arno Kerling
- Institute of Sports Medicine, Hannover Medical School, Hannover, Germany
| | - Anette Melk
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
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3
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Agbaje AO. Longitudinal left ventricular mass indexing for DEXA-measured lean mass and fat mass: novel normative reference centiles in postpubertal adolescents and young adults. Am J Physiol Heart Circ Physiol 2023; 324:H571-H577. [PMID: 36827226 PMCID: PMC10042592 DOI: 10.1152/ajpheart.00045.2023] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023]
Abstract
Left ventricular (LV) hypertrophy derived from LV mass (LVM) cut point is a marker of cardiovascular events in adults and target organ damage in pediatric research. Inadequate LVM indexing for body size due to scarcity of dual-energy X-ray absorptiometry (DEXA)-measured lean mass may lead to misclassification in the pediatric population. The only LVM indexed for DEXA-measured lean mass reference in children, mean age 11.6 yr, is 3-decades old and accurate LVM indexing in postpubertal adolescents and young adults is nonexistent. We generate new sex-specific LVM indexed for lean mass percentiles in healthy adolescence and young adulthood and correlated them with surrogates for normalizing body size. From the Avon Longitudinal Study of Parents and Children UK birth cohort, 868 adolescents (531 females) aged 17 yr were followed up for 7 yr. Lean mass was measured by DEXA at both time points. Echocardiography M-mode, two-dimensional (2-D), and three-dimensional (3-D) echo data for estimating LVM were collected at baseline and follow-up. Over 7 years, LVM increased in males (177.1 g) and females (133.5 g) at 17 yr to 199.9 g (males) and 145 g (females) at 24 yr. LVM/height3 and LVM/height2.7 provided the most consistent cross-sectional and longitudinal intraclass correlation coefficients with LVM/lean mass in both sexes (0.90-0.93). Indexing LVM by lean mass eliminated the sex difference only at age 24 yr but not at 17 yr. LVM/height2.7 85th percentiles for males and females at age 17 yr were 45.1 g/m2.7 and 41.4 g/m2.7, respectively, and at age 24 yr the 75th percentiles were 45.5 g/m2.7 and 41.7 g/m2.7, respectively. The 95th percentiles for males and females at age 17 yr were 49.5 g/m2.7 and 46.8 g/m2.7, respectively, and at age 24 yr were 57.1 g/m2.7 and 50.2 g/m2.7, respectively. These new reference percentile cut points were higher than the currently used 95th percentile pediatric reference of 38.6 g/m2.7. Future studies are warranted in youth with clinical diseases to examine whether these new cut points provide a more accurate stratification of cardiovascular risk.NEW & NOTEWORTHY Current left ventricular mass cut points for pediatric left ventricular hypertrophy are inaccurate. The inaccuracies are due, in part, to the average age of participants (11.6 yr) evaluated and also due to the lack of Echo and DEXA-measured body composition in postpubertal youth. Novel sex-based cut points are proposed for postpubertal youths at 17 and 24 yr. The new 95th percentile cut points are 15-20 g/m2.7 higher than the current cut point.
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Affiliation(s)
- Andrew O Agbaje
- Institute of Public Health and Clinical Nutrition, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
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4
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Le Page AK, Nagasundaram N, Horton AE, Johnstone LM. Echocardiogram screening in pediatric dialysis and transplantation. Pediatr Nephrol 2023; 38:957-74. [PMID: 36114889 DOI: 10.1007/s00467-022-05721-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 10/14/2022]
Abstract
Transthoracic echocardiography is commonly used to identify structural and functional cardiac abnormalities that can be prevalent in childhood chronic kidney failure (KF). Left ventricular mass (LVM) increase is most frequently reported and may persist post-kidney transplant especially with hypertension and obesity. While systolic dysfunction is infrequently seen in childhood chronic KF, systolic strain identified by speckle tracking echocardiography has been frequently identified in dialysis and it can also persist post-transplant. Echocardiogram association with long-term outcomes has not been studied in childhood KF but there are many adult studies demonstrating associations between increased LVM, systolic dysfunction, strain, diastolic dysfunction, and cardiovascular events and mortality. There has been limited study of interventions to improve echocardiogram status. In childhood, improved blood pressure has been associated with better LVM, and conversion from hemodialysis to hemodiafiltration has been associated with better diastolic and systolic function. Whether long-term cardiac outcomes are also improved with these interventions is unclear. Echocardiography is a well-established technique, and regular use in childhood chronic KF seems justified. A case can be made to extend screening to include speckle tracking echocardiography and intradialytic studies in high-risk populations. Further longitudinal studies including these newer echocardiogram modalities, interventions, and long-term outcomes would help clarify recommendations for optimal use as a screening tool.
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5
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Wu Y, Li Z, Du B, Ye Y, Wang H, Niu Y, Chen S, Wu Y, Jin H, Zhang X, Wang J, Sun K. Different Associations of Systolic Blood Pressure and Body Mass Index With Cardiac Structure and Function in Young Children. Hypertension 2022; 79:2583-2592. [DOI: 10.1161/hypertensionaha.122.19396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Yujian Wu
- Department of Pediatric Cardiology (Yujian Wu, Z.L., B.D., H.W., Y.N., S.C., Yurong Wu, J.W., K.S.), Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Zhuoyan Li
- Department of Pediatric Cardiology (Yujian Wu, Z.L., B.D., H.W., Y.N., S.C., Yurong Wu, J.W., K.S.), Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Bowen Du
- Department of Pediatric Cardiology (Yujian Wu, Z.L., B.D., H.W., Y.N., S.C., Yurong Wu, J.W., K.S.), Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Yujiao Ye
- Children's Heart Center, Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu, China (Y.Y.)
| | - Hualin Wang
- Department of Pediatric Cardiology (Yujian Wu, Z.L., B.D., H.W., Y.N., S.C., Yurong Wu, J.W., K.S.), Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Yiwei Niu
- Department of Pediatric Cardiology (Yujian Wu, Z.L., B.D., H.W., Y.N., S.C., Yurong Wu, J.W., K.S.), Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Sun Chen
- Department of Pediatric Cardiology (Yujian Wu, Z.L., B.D., H.W., Y.N., S.C., Yurong Wu, J.W., K.S.), Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Yurong Wu
- Department of Pediatric Cardiology (Yujian Wu, Z.L., B.D., H.W., Y.N., S.C., Yurong Wu, J.W., K.S.), Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Hong Jin
- Ministry of Education-Shanghai Key Laboratory of Children’s Environmental Health (H.J.), Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Xi Zhang
- Clinical Research Unit (X.Z.), Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Jian Wang
- Department of Pediatric Cardiology (Yujian Wu, Z.L., B.D., H.W., Y.N., S.C., Yurong Wu, J.W., K.S.), Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Kun Sun
- Department of Pediatric Cardiology (Yujian Wu, Z.L., B.D., H.W., Y.N., S.C., Yurong Wu, J.W., K.S.), Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
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6
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Umer M, Motwani M, Jefferies JL, Kalra DK. Cardiac involvement in Fabry Disease and the Role of Multimodality Imaging in Diagnosis and Disease Monitoring. Curr Probl Cardiol 2022; 48:101439. [DOI: 10.1016/j.cpcardiol.2022.101439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 09/30/2022] [Indexed: 11/16/2022]
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Abstract
X-linked hypophosphatemia (XLH) is a rare genetic disorder with X-linked dominant inheritance. Mutations in the PHEX gene increase fibroblast growth factor 23 (FGF23) concentrations, causing loss of phosphorus at the proximal tubule. Most pediatric patients debut in the first two years with short stature and bowed legs. Conventional treatment consists of oral supplements with phosphorus and calcitriol. Since 2018, burosumab has been approved as a novel therapeutic option for XLH, with promising results. The purpose of this study was to share our experience with two cases of XLH treated with burosumab. These patients presented with a broad phenotypical differences. One had the most severe radiological phenotype and developed left ventricular hypertrophy (LVH) and left ventricular dysfunction with preserved ejection fraction. Treatment with burosumab was well-tolerated and was followed by radiological stability and a striking improvement in both blood biochemistry and quality of life. The LVH was stable and left ventricular function normalized in the patient with cardiac involvement. In recent years many studies have been carried out to explain the role of FGF23 in cardiovascular damage, but the exact pathophysiological mechanisms are as yet unclear. The most intensively studied populations are patients with XLH or chronic kidney disease, as both are associated with high levels of FGF23. To date, cardiovascular involvement in XLH has been described in patients treated with conventional treatment, so it would be of interest to investigate if early use of burosumab at the time of diagnosis of XLH would prevent the occurrence of cardiovascular manifestations.
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Affiliation(s)
- Ana Castellano-Martinez
- Puerta del Mar University Hospital, Department of Pediatric Nephrology, Cadiz, Spain,* Address for Correspondence: Puerta del Mar University Hospital, Department of Pediatric Nephrology, Cadiz, Spain Phone: +34 956002700 E-mail:
| | - Silvia Acuñas-Soto
- Puerta del Mar University Hospital, Department of Pediatric Nephrology, Cadiz, Spain
| | - Virginia Roldan-Cano
- Puerta del Mar University Hospital, Department of Pediatric Nephrology, Cadiz, Spain
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8
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Olander RFW, Litwin L, Sundholm JKM, Sarkola T. Childhood cardiovascular morphology and function following abnormal fetal growth. Heart Vessels 2022; 37:1618-1627. [PMID: 35426503 PMCID: PMC9349157 DOI: 10.1007/s00380-022-02064-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 03/25/2022] [Indexed: 12/01/2022]
Abstract
Studies examining the link between abnormal fetal growth and cardiac changes in childhood have presented conflicting results. We studied the effect of abnormal fetal growth on cardiac morphology and function during childhood, while controlling for body size, composition and postnatal factors. We report on the follow-up of 90 children (median age 5.81 years, IQR 5.67; 5.95) born appropriate for gestational age (AGA, N = 48), small for gestational age (SGA, N = 23), or large for gestational age (LGA, N = 19); SGA and LGA defined as birth weight Z-score < − 2 and > + 2, respectively. We examined the heart using echocardiography, including Doppler and strain imaging, in relation to anthropometrics, body composition, blood pressure, physical activity, and diet. Although groupwise differences in body size decreased during the first year after birth, LGA remained larger at follow-up, with higher lean body mass and BMI, while SGA were smaller. Slight changes in left ventricular diastolic function were present in SGA and LGA, with SGA showing increased mitral diastolic E- and A-wave peak flow velocities, and increased septal E/E′ ratio, and LGA showing larger left atrial volume adjusted for sex and lean body mass. In univariate analyses, lean body mass at follow-up was the strongest predictor of cardiac morphology. We found no groupwise differences at follow-up for ventricular sphericity, cardiac morphology adjusted for lean body mass and sex, or blood pressure, diet, or physical activity. Cardiac morphology is predicted by lean body mass during childhood, even in the setting of abnormal fetal growth. Our results are consistent with a limited effect of fetal programming on cardiac dimensions during childhood. Minor changes in diastolic function are present in both SGA and LGA children, however, the clinical significance of these changes at this stage is likely small.
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Affiliation(s)
- Rasmus F W Olander
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Stenbäckinkatu 9, POB 347, 00029, Helsinki, Finland.
- Minerva Foundation Institute for Medical Research, Helsinki, Finland.
| | - Linda Litwin
- Minerva Foundation Institute for Medical Research, Helsinki, Finland
- Department of Congenital Heart Defects and Pediatric Cardiology, FMS, Medical University of Silesia, Katowice, Poland
| | - Johnny K M Sundholm
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Stenbäckinkatu 9, POB 347, 00029, Helsinki, Finland
- Minerva Foundation Institute for Medical Research, Helsinki, Finland
| | - Taisto Sarkola
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Stenbäckinkatu 9, POB 347, 00029, Helsinki, Finland
- Minerva Foundation Institute for Medical Research, Helsinki, Finland
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9
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von der Born J, Baberowski S, Memaran N, Grams L, Homeyer D, Borchert-Mörlins B, Sugianto RI, Paulsen M, Bauer E, Grabitz C, Schmidt BMW, Kerling A, Beerbaum P, Stiesch M, Tegtbur U, Melk A. Impact of Sex and Obesity on Echocardiographic Parameters in Children and Adolescents. Pediatr Cardiol 2022; 43:1502-16. [PMID: 35394150 DOI: 10.1007/s00246-022-02876-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 03/15/2022] [Indexed: 12/04/2022]
Abstract
Subclinical alterations in left ventricular structure and function are detectable in adolescents with hypertension or obesity. However, data on early echocardiographic abnormalities in seemingly healthy children are lacking. Sex differences in cardiac structure and function have been previously reported, but sex-specific reference values are not available. Specifically, the potential interaction of sex and overweight has not been addressed at all. Anthropometric data, blood pressure and exercise tests were obtained in 356 healthy children. Echocardiographic parameters comprised peak early (E) and late (A) mitral inflow Doppler velocities, E/A ratio, tissue Doppler peak velocities of early (e') and late diastolic (a') excursion of mitral/septal annulus and isovolumetric relaxation time (IVRT). Left ventricular mass index (LVMI) and LVMI z-score were calculated. Interaction terms between BMI and sex and stratification by sex were used for analysis. We provide values for echocardiographic parameters for children of two age groups separated by BMI. Overweight/obese children had a significant higher LVMI, lower E/A ratio, higher E/e' ratios and a longer IVRT. For a given BMI in the upper ranges we demonstrated a higher LVMI in girls than in boys, the IVRT extended significantly more in girls than in boys with increasing BMI. There are sex differences in structural and functional echocardiographic parameters in children and adolescents. Our data not only confirms the importance of overweight and obesity, but demonstrates important interactions between sex and overweight. The greater susceptibility of overweight girls toward echocardiographic changes associated with potential long-term functional impairment needs further exploration and follow-up.Trial registration number DRKS00012371; Date 18.08.2017.
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Westphal Ladfors S, Bergdahl E, Hermannsson O, Kristjansson J, Linnér T, Brandström P, Hansson S, Dangardt F. Longitudinal Follow-Up on Cardiopulmonary Exercise Capacity Related to Cardio-Metabolic Risk Factors in Children With Renal Transplants. Front Sports Act Living 2021; 3:688383. [PMID: 34485901 PMCID: PMC8415396 DOI: 10.3389/fspor.2021.688383] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/19/2021] [Indexed: 01/02/2023] Open
Abstract
Background: Children with chronic kidney disease, including those treated with kidney transplantation (KT), have an increased risk of cardiovascular disease. The aim of this study was to examine the cardiopulmonary exercise capacity after KT compared to matched controls, to relate the results to physical activity, blood pressure and biochemical findings and to follow exercise capacity over time. Methods: Patients with KT (n = 38, age 7.7–18 years), with a mean time from transplantation of 3.7 years (0.9–13.0) and mean time in dialysis 0.8 years, were examined at inclusion and annually for up to three years. Healthy controls (n = 17, age 7.3–18.6 years) were examined once. All subjects underwent a cardiopulmonary exercise test, resting blood pressure measurement, anthropometry and activity assessment. Patients also underwent echocardiography, dual-energy X-ray absorptiometry (DXA), 24-h ambulatory BP measurements (ABPM), assessment of glomerular filtration rate (GFR) and blood sampling annually. Results: As compared to healthy controls, KT patients showed decreased exercise capacity measured both as VO2peak (34.5 vs. 43.9 ml/kg/min, p < 0.001) and maximal load (2.6 vs. 3.5 W/kg, p < 0.0001), similarly as when results were converted to z-scores. No significant difference was found in weight, but the KT patients were shorter and had higher BMI z-score than controls, as well as increased resting SBP and DBP z-scores. The patient or parent reported physical activity was significantly lower in the KT group compared to controls (p < 0.001) In the combined group, the major determinants for exercise capacity z-scores were activity score and BMI z-score (β = 0.79, p < 0.0001 and β = −0.38, p = 0.007, respectively). Within the KT group, low exercise capacity was associated with high fat mass index (FMI), low activity score, low GFR and high blood lipids. In the multivariate analysis FMI and low GFR remained predictors of low exercise capacity. The longitudinal data for the KT patients showed no change in exercise capacity z-scores over time. Conclusion: Patients with KT showed decreased exercise capacity and increased BP as compared to healthy controls. Exercise capacity was associated to GFR, physical activity, FMI and blood lipids. It did not improve during follow-up.
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Affiliation(s)
| | - Ebba Bergdahl
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Oli Hermannsson
- Pediatric Nephrology, The Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Julius Kristjansson
- Pediatric Nephrology, The Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Tina Linnér
- Pediatric Nephrology, The Queen Silvia Children's Hospital, Gothenburg, Sweden.,Pediatric Clinical Physiology, The Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Per Brandström
- Pediatric Nephrology, The Queen Silvia Children's Hospital, Gothenburg, Sweden.,Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sverker Hansson
- Pediatric Nephrology, The Queen Silvia Children's Hospital, Gothenburg, Sweden.,Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Frida Dangardt
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Pediatric Clinical Physiology, The Queen Silvia Children's Hospital, Gothenburg, Sweden
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11
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Övünç Hacıhamdioğlu D, Ceylan Ö, Yardımcı AH. Could arterial stiffness be early reversible target organ damage test in childhood hypertension? Anatol J Cardiol 2021; 25:496-504. [PMID: 34236325 DOI: 10.5152/anatoljcardiol.2021.67927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The recommended treatment for hypertension (HTN) in children has been revised recently. This study aimed to present the changes in target organ damage (TOD) and arterial stiffness parameters after treatment in children with primary HTN who were managed in accordance with the 2016 European Society of Hypertension Guidelines. METHODS Patients with primary HTN included in this study were newly diagnosed, untreated, and were followed-up for a minimum of 6 months. HTN was confirmed by 24-h ambulatory blood pressure monitoring (ABPM). All patients underwent the following assessments: anthropometrical measurements of body mass index (BMI), carotid intima-media thickness (cIMT), left ventricular mass index (LVMI), plasma creatinine, urea, electrolytes, uric acid, fasting plasma glucose, blood lipids, urinalysis, urine culture, and first morning urine albumin tocreatinine ratio. The ABPM device performed measurements such as central blood pressure (cBP) and pulse wave velocity (PWV). RESULTS Thirty-two of 104 patients were enrolled. Seventeen patients were male, and 53% were obese. Compared with pretreatment, creatinine, urea, systolic BP (SBP), diastolic BP (DBP), systolic load, diastolic load, central SBP (cSBP), cSBP z score, cDBP, and PWV z score decreased, whereas LVMI and BMI z scores were unchanged. CONCLUSION After BP improvement, while LVMI did not regress, the cSBP, cSBP z, and PWV z score values, which are markers of arterial stiffness, regressed. This supports the corrective effect of BP control on the cardiovascular system even in a short-term follow-up. Further longitudinal studies are needed for the assessment of BP control on arterial stiffness in childhood.
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Affiliation(s)
- Duygu Övünç Hacıhamdioğlu
- Division of Pediatric Nephrology, Department of Pediatrics, Faculty of Medicine, Bahçeşehir University, Medical Park Göztepe Hospital; İstanbul-Turkey;Division of Pediatric Nephrology, Department of Pediatrics, University of Health Sciences, Süleymaniye Women Maternity and Child Diseases Training and Research Hospital; İstanbul-Turkey
| | - Özben Ceylan
- Division of Pediatric Cardiology, Department of Pediatrics, University of Health Sciences, Süleymaniye Women Maternity and Child Diseases Training and Research Hospital; İstanbul-Turkey;Department of Pediatric Cardiology, University of Health Sciences, İstanbul Training and Research Hospital; İstanbul-Turkey
| | - Aytül Hande Yardımcı
- Department of Radiology, University of Health Sciences, İstanbul Training and Research Hospital; İstanbul-Turkey
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12
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Jeyaprakash P, Moussad A, Pathan S, Sivapathan S, Ellenberger K, Madronio C, Thomas L, Negishi K, Pathan F. A Systematic Review of Scaling Left Atrial Size: Are Alternative Indexation Methods Required for an Increasingly Obese Population? J Am Soc Echocardiogr 2021; 34:1067-1076.e3. [PMID: 34023453 DOI: 10.1016/j.echo.2021.05.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 05/12/2021] [Accepted: 05/12/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Left atrial (LA) size indexed to body surface area (BSA) is a clinically important marker of cardiovascular prognosis. However, indexation using a scaling variable such as BSA has inherent flaws, particularly in an obese population. The aim of this study was to determine whether alternative indexation methods may more accurately scale for LA size. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to execute a structured search of medical databases, to identify articles discussing alternative methods of LA indexation in echocardiography. Articles that stratified indexed LA size by obesity class were also included. Two independent reviewers identified relevant articles and extracted baseline characteristics, alternative indexation methods, scaling variables, obesity class characteristics, and correlation coefficients. RESULTS A total of 3,804 articles were found in the database search after removing duplicates. After abstract and full-text screening, 13 relevant articles were identified. Twelve studies used alternative methods of LA indexation, of which nine reported allometric indices. Seven of the included studies reported LA size by obesity class, of which six reported alternative indices. Correlation coefficients plotted for indexed LA size against absolute measured LA size showed that allometric indices (specifically to height) were more likely to maintain proportionality to body size compared with isometric indices such as BSA. Allometric indices were less likely to overcorrect for body size compared with isometric indices. CONCLUSIONS Compared with isometric indexation to BSA, allometric indexation (specifically to height) improves scaling of LA volumes to maintain proportionality and avoid overcorrection for body size.
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Affiliation(s)
- Prajith Jeyaprakash
- Department of Cardiology, Nepean Hospital, Sydney, Australia; Sydney Medical School Nepean, Faculty of Medicine and Health, Charles Perkins Centre Nepean, The University of Sydney, New South Wales, Sydney, Australia
| | - Andrew Moussad
- Department of Cardiology, Nepean Hospital, Sydney, Australia; Sydney Medical School Nepean, Faculty of Medicine and Health, Charles Perkins Centre Nepean, The University of Sydney, New South Wales, Sydney, Australia
| | - Shahab Pathan
- Sydney Medical School Nepean, Faculty of Medicine and Health, Charles Perkins Centre Nepean, The University of Sydney, New South Wales, Sydney, Australia; Department of Cardiology, Concord Hospital, Sydney, Australia
| | - Shanthosh Sivapathan
- Department of Cardiology, Nepean Hospital, Sydney, Australia; Sydney Medical School Nepean, Faculty of Medicine and Health, Charles Perkins Centre Nepean, The University of Sydney, New South Wales, Sydney, Australia
| | - Katherine Ellenberger
- Department of Cardiology, Nepean Hospital, Sydney, Australia; Sydney Medical School Nepean, Faculty of Medicine and Health, Charles Perkins Centre Nepean, The University of Sydney, New South Wales, Sydney, Australia
| | - Christine Madronio
- Department of Cardiology, Nepean Hospital, Sydney, Australia; Sydney Medical School Nepean, Faculty of Medicine and Health, Charles Perkins Centre Nepean, The University of Sydney, New South Wales, Sydney, Australia
| | - Liza Thomas
- Cardiology Department, Westmead Hospital, Sydney, Australia; Sydney Medical School Westmead, Faculty of Medicine and Health, Charles Perkins Centre Westmead, Sydney, Australia
| | - Kazuaki Negishi
- Department of Cardiology, Nepean Hospital, Sydney, Australia; Sydney Medical School Nepean, Faculty of Medicine and Health, Charles Perkins Centre Nepean, The University of Sydney, New South Wales, Sydney, Australia
| | - Faraz Pathan
- Department of Cardiology, Nepean Hospital, Sydney, Australia; Sydney Medical School Nepean, Faculty of Medicine and Health, Charles Perkins Centre Nepean, The University of Sydney, New South Wales, Sydney, Australia.
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13
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Murphy MO, Huang H, Bauer JA, Schadler A, Makhoul M, Clasey JL, Chishti AS, Kiessling SG. Impact of Pediatric Obesity on Diurnal Blood Pressure Assessment and Cardiovascular Risk Markers. Front Pediatr 2021; 9:596142. [PMID: 33748038 PMCID: PMC7969716 DOI: 10.3389/fped.2021.596142] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 02/05/2021] [Indexed: 12/28/2022] Open
Abstract
Background: The prevalence of hypertension is increasing particularly among obese children and adolescents. Obese children and adolescents with hypertension are likely to remain hypertensive as they reach adulthood and hypertension is linked to an increased risk for cardiovascular disease. Twenty-four-hour ambulatory blood pressure monitoring (ABPM) has become one of the most important tools in diagnosing hypertension in children and adolescents and circadian patterns of blood pressure may be important disease-risk predictors. Methods: A retrospective chart review was conducted in patients aged 6-21 years who underwent 24-h ABPM at Kentucky Children's Hospital (KCH) from August 2012 through June 2017. Exclusion criteria included conditions that could affect blood pressure including chronic kidney disease and other renal abnormalities, congenital heart disease, cancer, and thyroid disease. Subjects were categorized by body mass index into normal (below 85th percentile), overweight (85th-95th percentile), stage I obesity (95th-119th percentile), stage II obesity (120th-139th) and stage III obesity (>140th). Non-dipping was defined as a nocturnal BP reduction of <10%. Results: Two hundred and sixty-three patients (156 male patients) were included in the analysis, of whom 70 were normal weight, 33 overweight, 55 stage I obesity, 53 stage II, and 52 stage III obesity. Although there was no significant difference between normal weight and obese groups for prevalence of hypertension, there was a greater prevalence of SBP non-dipping in obese patients as BMI increased (p = 0.008). Furthermore, non-dippers had a significantly elevated LVMI as well as abnormal lab values for uric acid, blood lipid panel, creatinine, and TSH (p < 0.05). Conclusions: These findings demonstrate that obese children and adolescents constitute a large proportion of hypertensive children and adolescents and the severity of pediatric obesity is associated with nocturnal BP non-dipping. Additionally, obesity in children is linked to several cardiovascular risk factors including left ventricular hypertrophy, dyslipidemia, and elevated uric acid levels. Further studies utilizing ABPM measures on risk stratification in this very high-risk population are warranted.
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Affiliation(s)
- Margaret O Murphy
- Division of Pediatric Nephrology, Department of Pediatrics, University of Kentucky, Lexington, KY, United States
| | - Hong Huang
- Department of Pediatrics, University of Kentucky, Lexington, KY, United States
| | - John A Bauer
- Department of Pediatrics, University of Kentucky, Lexington, KY, United States
| | - Aric Schadler
- Department of Pediatrics, University of Kentucky, Lexington, KY, United States
| | - Majd Makhoul
- Division of Pediatric Cardiology, Department of Pediatrics, University of Kentucky, Lexington, KY, United States
| | - Jody L Clasey
- Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, KY, United States
| | - Aftab S Chishti
- Division of Pediatric Nephrology, Department of Pediatrics, University of Kentucky, Lexington, KY, United States
| | - Stefan G Kiessling
- Division of Pediatric Nephrology, Department of Pediatrics, University of Kentucky, Lexington, KY, United States
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14
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Litwin L, Sundholm JKM, Rönö K, Koivusalo SB, Eriksson JG, Sarkola T. No effect of gestational diabetes or pre-gestational obesity on 6-year offspring left ventricular function-RADIEL study follow-up. Acta Diabetol 2020; 57:1463-1472. [PMID: 32725413 PMCID: PMC7591425 DOI: 10.1007/s00592-020-01571-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/05/2020] [Indexed: 01/20/2023]
Abstract
AIMS We aimed to investigate associations between pre-pregnancy obesity, gestational diabetes (GDM), offspring body composition, and left ventricular diastolic and systolic function in early childhood. METHODS This is an observational study, including 201 mother-child pairs originating from the Finnish Gestational Diabetes Prevention Study (RADIEL; 96 with GDM, 128 with pre-pregnancy obesity) with follow-up from gestation to 6-year postpartum. Follow-up included dyads anthropometrics, body composition, blood pressure, and child left ventricular function with comprehensive echocardiography (conventional and strain imaging). RESULTS Offspring left ventricular diastolic and systolic function was not associated with gestational glucose concentrations, GDM, or pregravida obesity. Child body fat percentage correlated with maternal pre-pregnancy BMI in the setting of maternal obesity (r = 0.23, P = 0.009). After adjusting for child lean body mass, age, sex, systolic BP, resting HR, maternal lean body mass, pre-gestational BMI, and GDM status, child left atrial volume increased by 0.3 ml (95% CI 0.1, 0.5) for each 1% increase in child body fat percentage. CONCLUSIONS No evidence of foetal cardiac programming related to GDM or maternal pre-pregnancy obesity was observed in early childhood. Maternal pre-pregnancy obesity is associated with early weight gain. Child adiposity in early childhood is independently associated with increased left atrial volume, but its implications for long-term left ventricle diastolic function and cardiovascular health remain unknown.
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Affiliation(s)
- Linda Litwin
- Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Congenital Heart Defects and Pediatric Cardiology, FMS in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Johnny K. M. Sundholm
- Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kristiina Rönö
- Women’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Saila B. Koivusalo
- Women’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Johan G. Eriksson
- University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Taisto Sarkola
- Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Minerva Foundation Institute for Medical Research, Helsinki, Finland
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15
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Krysztofiak H, Młyńczak M, Małek ŁA, Folga A, Braksator W. Left ventricular mass normalization in child and adolescent athletes must account for sex differences. PLoS One 2020; 15:e0236632. [PMID: 32716972 DOI: 10.1371/journal.pone.0236632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 07/10/2020] [Indexed: 11/25/2022] Open
Abstract
Background To assess left ventricular hypertrophy, actual left ventricular mass (LVM) normalized for body size has to be compared to the LVM normative data. However, only some published normative echocardiographic data have been produced separately for girls and boys; numerous normative data for the pediatric population are not sex-specific. Thus, this study aimed to assess whether the LVM normative data should be developed separately for girls and boys practicing sports. Methods Left ventricular mass was computed for 331 girls and 490 boys, 5–19 years old, based on echocardiography. The effect of sex on the relationship between LVM and body size was evaluated using a linear regression model. Seven sets of the LVM normative data were developed, using different methodologies, to test concordance between sex-specific and non-specific normative data. Every set consisted of normative data that was sex-specific and non-specific. Upon these normative data, for every study participant, seven pairs of LVM z-scores were calculated based on her/his actual LVM. Each pair consisted of z-scores computed based on sex-specific and non-specific normative data from the same set. Results The regression lines fitted to the data points corresponding to LVM of boys had a higher slope than of girls, indicating that sex affects the relationship between LVM and body size. The mean differences between the paired LVM z-scores differed significantly from 0. The percentage of discordant indications, depending on the normalization method, ranged from 66.7% to 100% in girls and from 35.4% to 50% in boys. Application of the LVM normative data that were not sex-specific made relative LVM underestimated in girls and overestimated in boys. Conclusion The LVM normative data should be developed separately for girls and boys practicing sports. Application of normative data that are not sex-specific results in an underestimation of relative LVM in girls and overestimation in boys.
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Abstract
The systematic development of early age talent in sports academies has led to the professionalization of pediatric sport and the sports physician need to be aware of pediatric cardiological problems. Research into the medical cardiac care and assessment of the pediatric athlete are accumulating, but specific pediatric international guidelines are not available yet and reference data for ECG and echocardiography are incomplete, in particular for the age group <12 years of age. This article is an introduction to the physiological and diagnostics specifics of the pediatric athlete. The focus lies in the differences in presentation and diagnosis between pediatric and adult athletes for the most common pathologies. Reference data for electrical and structural adaptations to intensive exercise are sparse particularly in athletes aged below 12 years old. Training related changes include decrease of resting heart rate, increase of cardiac output, ventricular cavity size, and wall thickness. Cardiac hypertrophy is less pronounced in pediatric athletes, as HR mediated cardiac output increase to endurance exercise is the dominant mechanism in peripubertal children. As in adults, the most pronounced cardiovascular adaptations appear in classical endurance sports like rowing, triathlon, and swimming, but the specifics of pediatric ECG and echocardiographic changes need to be considered.
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Affiliation(s)
- Guido E Pieles
- National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Centre, Congenital Heart Unit, Bristol Heart Institute, Bristol, UK.,Institute of Sport, Exercise and Health, University College London, London, UK
| | - A Graham Stuart
- National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Centre, Congenital Heart Unit, Bristol Heart Institute, Bristol, UK
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17
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Choi AW, Fong NC, Li VW, Ho TW, Chan EY, Ma AL, Cheung YF. Left ventricular stiffness in paediatric patients with end-stage kidney disease. Pediatr Nephrol 2020; 35:1051-60. [PMID: 32016625 DOI: 10.1007/s00467-020-04484-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 12/20/2019] [Accepted: 01/15/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND We tested the hypothesis that myocardial stiffness is altered in paediatric patients with end-stage kidney disease (ESKD) and explored its association with clinical parameters of chronic kidney disease (CKD). METHODS Thirty-five patients with ESKD (16 males) aged 17.5 ± 3 years old, 18/35 of whom were receiving dialysis and 17 post kidney transplant, were studied. Left ventricular (LV) myocardial stiffness was determined by measurement of diastolic wall strain (DWS) and stiffness index (SI), while LV diastolic function was interrogated by pulsed-wave and tissue Doppler echocardiography. RESULTS Compared with available literature data, both dialysis and transplanted patients had significantly lower DWS and greater SI, reduced transmitral early (E) to late diastolic velocity ratio and septal and lateral mitral annular early (e') diastolic velocities, and greater septal and lateral E/e' ratios (all p < 0.05). Multivariate analysis revealed that z score of diastolic blood pressure (β = 0.43, p = 0.004) and the duration of renal replacement therapy (β = 0.55, p < 0.001) were significant determinants of LV SI. Subgroup analysis in post-transplant patients showed z score of diastolic blood pressure (β = 0.54, p = 0.025) remained as a significant determinant of LV SI. CONCLUSION Increased LV myocardial stiffness is evident in paediatric dialysis and transplanted patients with ESKD, and is associated with blood pressure and duration of renal replacement therapy.
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Abstract
The success of systematic early age talent development has led to the professionalisation of youth sports academies used by clubs and governing bodies alike, and sports physicians are nowadays commonly confronted with paediatric cardiological problems. Medical cardiac care of the paediatric athlete is however in its infancy, and the international guidelines that are present for adult athletes, are not yet available. Similarly, reference data for ECG and echocardiography are incomplete. The aim of this article is to provide and introduction to the cardiac care of the paediatric athlete to facilitate healthy and above all, safe talent development, but also provide guidance on how to distinguish adaptive, beneficial cardiovascular remodelling from underlying pathology of congenital or inherited cardiovascular disease. Differences in presentation, diagnosis and treatment between childhood and adult athletes are highlighted and can educate the reader in the emerging field of paediatric sports cardiology.
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Affiliation(s)
- Guido E Pieles
- Congenital Heart Unit, Bristol Heart Institute, Upper Maudlin Street, Bristol, BS2 8BJ, UK.
| | - Renate Oberhoffer
- Department of Sports and Health Sciences, Technical University Munich, Georg Brauchle Ring, 80992, Munich, Germany
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19
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Shea JR, Henshaw MH, Carter J, Chowdhury SM. Lean body mass is the strongest anthropometric predictor of left ventricular mass in the obese paediatric population. Cardiol Young 2020; 30:476-81. [PMID: 32172704 DOI: 10.1017/S1047951120000311] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Indexing left ventricular mass to body surface area or height2.7 leads to inaccuracies in diagnosing left ventricular hypertrophy in obese children. Lean body mass predictive equations provide the opportunity to determine the utility of lean body mass in indexing left ventricular mass. Our objectives were to compare the diagnostic accuracy of predicted lean body mass, body surface area, and height in detecting abnormal left ventricle mass in obese children. METHODS Obese non-hypertensive patients aged 4-21 years were recruited prospectively. Dual-energy X-ray absorptiometry was used to measure lean body mass. Height, weight, sex, race, and body mass index z-score were used to calculate predicted lean body mass. RESULTS We enrolled 328 patients. Average age was 12.6 ± 3.8 years. Measured lean body mass had the strongest relationship with left ventricular mass (R2 = 0.84, p < 0.01) compared to predicted lean body mass (R2 = 0.82, p < 0.01), body surface area (R2 = 0.80, p < 0.01), and height2.7 (R2 = 0.65, p < 0.01). Of the clinically derived variables, predicted lean body mass was the only measure to have an independent association with left ventricular mass (β = 0.90, p < 0.01). Predicted lean body mass was the most accurate scaling variable in detecting left ventricular hypertrophy (positive predictive value = 88%, negative predictive value = 99%). CONCLUSIONS Lean body mass is the strongest predictor of left ventricular mass in obese children. Predicted lean body mass is the most accurate anthropometric scaling variable for left ventricular mass in left ventricular hypertrophy detection. Predicted lean body mass should be considered for clinical use as the body size correcting variable for left ventricular mass in obese children.
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Olivieri LJ, Jiang J, Hamann K, Loke YH, Campbell-Washburn A, Xue H, McCarter R, Cross R. Normal right and left ventricular volumes prospectively obtained from cardiovascular magnetic resonance in awake, healthy, 0- 12 year old children. J Cardiovasc Magn Reson 2020; 22:11. [PMID: 32013998 PMCID: PMC6998283 DOI: 10.1186/s12968-020-0602-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 01/13/2020] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Pediatric z scores are necessary to describe size and structure of the heart in growing children, however, development of an accurate z score calculator requires robust normal datasets, which are difficult to obtain with cardiovascular magnetic resonance (CMR) in children. Motion-corrected (MOCO) cines from re-binned, reconstructed real-time cine offer a free-breathing, rapid acquisition resulting in cines with high spatial and temporal resolution. In combination with child-friendly positioning and entertainment, MOCO cine technique allows for rapid cine volumetry in patients of all ages without sedation. Thus, our aim was to prospectively enroll normal infants and children birth-12 years for creation and validation of a z score calculator describing normal right ventricular (RV) and left ventricular (LV) size. METHODS With IRB approval and consent/assent, 149 normal children successfully underwent a brief noncontrast CMR on a 1.5 T scanner including MOCO cines in the short axis, and RV and LV volumes were measured. 20% of scans were re-measured for interobserver variability analyses. A general linear modeling (GLM) framework was employed to identify and properly represent the relationship between CMR-based assessments and anthropometric data. Scatter plots of model fit and Akaike's information criteria (AIC) results were used to guide the choice among alternative models. RESULTS A total of 149 subjects aged 22 days-12 years (average 5.1 ± 3.6 years), with body surface area (BSA) range 0.21-1.63 m2 (average 0.8 ± 0.35 m2) were scanned. All ICC values were > 95%, reflecting excellent agreement between raters. The model that provided the best fit of volume measure to the data included BSA with higher order effects and gender as independent variables. Compared with earlier z score models, there is important additional growth inflection in early toddlerhood with similar z score prediction in later childhood. CONCLUSIONS Free-breathing, MOCO cines allow for accurate, reliable RV and LV volumetry in a wide range of infants and children while awake. Equations predicting fit between LV and RV normal values and BSA are reported herein for purposes of creating z scores. TRIAL REGISTRATION clinicaltrials.gov NCT02892136, Registered 7/21/2016.
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Affiliation(s)
- Laura J Olivieri
- Division of Cardiology, Children's National Medical Center, W3-200, 111 Michigan Ave NW, Washington, DC, 20010, USA.
| | - Jiji Jiang
- Children's Research Institute, Children's National Medical Center, 111 Michigan Ave NW, Washington, DC, USA
| | - Karin Hamann
- Division of Cardiology, Children's National Medical Center, W3-200, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Yue-Hin Loke
- Division of Cardiology, Children's National Medical Center, W3-200, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | | | - Hui Xue
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Robert McCarter
- Children's Research Institute, Children's National Medical Center, 111 Michigan Ave NW, Washington, DC, USA
| | - Russell Cross
- Division of Cardiology, Children's National Medical Center, W3-200, 111 Michigan Ave NW, Washington, DC, 20010, USA
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Litwin L, Sundholm JKM, Rönö K, Koivusalo SB, Eriksson JG, Sarkola T. Transgenerational effects of maternal obesity and gestational diabetes on offspring body composition and left ventricle mass: the Finnish Gestational Diabetes Prevention Study (RADIEL) 6-year follow-up. Diabet Med 2020; 37:147-156. [PMID: 31344268 DOI: 10.1111/dme.14089] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/23/2019] [Indexed: 12/27/2022]
Abstract
AIM To investigate the influence of maternal adiposity and gestational diabetes on offspring body composition and left ventricle mass in early childhood. METHODS The observational follow-up study included 201 mother-child pairs, a sub-cohort from the Finnish Gestational Diabetes Prevention Study, who were recruited 6.1 ± 0.5 (mean ± SD) years postpartum, aiming for an equal number of mothers with and without gestational diabetes. RESULTS Maternal pre-pregnancy BMI (mean ± SD; 30.5 ± 5.6 kg/m2 ) was associated with child body fat percentage [0.26 (95% CI; 0.08, 0.44)% increase in child body fat per 1 kg/m2 increase in pre-pregnancy BMI of mothers with obesity] and was reflected in child BMI Z-score (mean ± SD; 0.45 ± 0.93). Left ventricle mass, left ventricle mass index and left ventricle mass Z-score were not associated with gestational diabetes, pre-pregnancy BMI or child body fat percentage. After adjusting for child sex, body fat percentage, systolic blood pressure, pre-pregnancy BMI and maternal lean body mass, left ventricle mass increased by 3.08 (95% CI; 2.25, 3.91) g for each 1 kg in child lean body mass. CONCLUSIONS Left ventricle mass at 6 years of age is determined predominantly by lean body mass. Maternal pre-gestational adiposity is reflected in child, but no direct association between left ventricle mass and child adiposity or evidence of left ventricle mass foetal programming related to gestational diabetes and maternal adiposity was observed in early childhood.
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Affiliation(s)
- L Litwin
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Congenital Heart Defects and Pediatric Cardiology, SMDZ in Zabrze, SUM, Katowice, Poland
| | - J K M Sundholm
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - K Rönö
- Women's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - S B Koivusalo
- Women's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - J G Eriksson
- University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
| | - T Sarkola
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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22
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Krysztofiak H, Młyńczak M, Małek ŁA, Folga A, Braksator W. Left ventricular mass normalization for body size in children based on an allometrically adjusted ratio is as accurate as normalization based on the centile curves method. PLoS One 2019; 14:e0225287. [PMID: 31751386 PMCID: PMC6872180 DOI: 10.1371/journal.pone.0225287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 10/31/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Normalization for body size is required for reliable left ventricular mass (LVM) evaluation, especially in children due to the large variability of body size. In clinical practice, the allometrically adjusted ratio of LVM to height raised to the power of 2.7 is often used. However, studies presenting normative LVM data for children recommend centile curves as optimal for the development of normative data. This study aimed to assess whether the allometrically adjusted LVM-to-height ratio can reliably reproduce the results of LVM normalization for height based on the centile curves method. METHODS Left ventricular mass was computed for 464 boys and 327 girls, 5-18 years old, based on echocardiographic examination. Normalized data representing LVM for height were developed using the centile curves construction method and two variants of the allometrically adjusted ratio method: one variant with the allometric exponents specific to the study groups, and one variant with the universal exponent of 2.7. The agreement between the allometric methods and the centile curves method was analyzed using the concordance correlation coefficient, sensitivity, and specificity. RESULTS For both the specific allometric variant and the universal variant, the analysis of concordance has indicated high reproducibility compared to the centile curves method. The respective coefficient values were 0.9917 and 0.9916 for girls, and 0.9886 and 0.9869 for boys. The sensitivity and specificity test has also shown high agreement. However, for girls, the sensitivity was higher for the specific variant (100% vs. 90.9%). CONCLUSION The results of the study show that allometric scaling of LVM for height can very reliably reproduce the results of LVM normalization for height based on the centile curves method. However, the analysis of sensitivity and specificity indicates greater agreement for the allometric normalization with the group-specific allometric exponents.
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Affiliation(s)
- Hubert Krysztofiak
- Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
- National Centre for Sports Medicine, Warsaw, Poland
- * E-mail:
| | - Marcel Młyńczak
- Warsaw University of Technology, Faculty of Mechatronics, Institute of Metrology and Biomedical Engineering, Warsaw, Poland
| | - Łukasz A. Małek
- Department of Epidemiology, Cardiovascular Disease Prevention and Health Promotion, National Institute of Cardiology, Warsaw, Poland
| | | | - Wojciech Braksator
- Department of Sports Cardiology and Noninvasive Cardiovascular Imaging, 2nd Medical Faculty, Medical University of Warsaw, Warsaw, Poland
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Arnold M, Linden A, Clarke R, Guo Y, Du H, Bian Z, Wan E, Yang M, Wang L, Chen Y, Chen J, Long H, Gu Q, Collins R, Li L, Chen Z, Parish S. Carotid Intima-Media Thickness but Not Carotid Artery Plaque in Healthy Individuals Is Linked to Lean Body Mass. J Am Heart Assoc 2019; 8:e011919. [PMID: 31364443 PMCID: PMC6761650 DOI: 10.1161/jaha.118.011919] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 06/11/2019] [Indexed: 01/08/2023]
Abstract
Background Lean body mass has been identified as a key determinant of left ventricular mass and wall thickness. However, the importance of lean body mass or other body-size measures as normative determinants of carotid intima-media thickness (cIMT), a widely used early indicator of atherosclerosis, has not been well established. Methods and Results Carotid artery ultrasound measurements of cIMT and carotid artery plaque burden (derived from plaque number and maximum size) and measurements of body size, including height, body mass index, weight, body fat proportion, and lean body mass ([1-body fat proportion]×weight), were recorded in 25 020 participants from 10 regions of China. Analyses were restricted to a healthy younger subset (n=6617) defined as never or long-term ex-regular smokers aged <60 years (mean age, 50) without previous ischemic heart disease, stroke, diabetes mellitus, or hypertension and with plasma non-high-density lipoprotein cholesterol <4 mmol/L. Among these 6617 participants, 86% were women (because most men smoked) and 9% had carotid artery plaque. In both women and men separately, lean body mass was strongly positively associated with cIMT, but was not associated with plaque burden: overall, each 10 kg higher lean body mass was associated with a 0.03 (95% CI, 0.03-0.04) mm higher cIMT (P=5×10-33). Fat mass, height, and other body-size measures were more weakly associated with cIMT. Conclusions The strong association of lean body mass with cIMT, but not with plaque burden, in healthy adults suggests a normative relationship rather than reflecting atherosclerotic pathology. Common mechanisms may underlie the associations of lean body mass with cIMT and with nonatherosclerotic vascular traits.
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Affiliation(s)
- Matthew Arnold
- Clinical Trial Service Unit and Epidemiological Studies UnitNuffield Department of Population HealthUniversity of OxfordOxfordUnited Kingdom
| | - Andrew Linden
- Clinical Trial Service Unit and Epidemiological Studies UnitNuffield Department of Population HealthUniversity of OxfordOxfordUnited Kingdom
| | - Robert Clarke
- Clinical Trial Service Unit and Epidemiological Studies UnitNuffield Department of Population HealthUniversity of OxfordOxfordUnited Kingdom
| | - Yu Guo
- Chinese Academy of Medical SciencesBeijingChina
| | - Huaidong Du
- Clinical Trial Service Unit and Epidemiological Studies UnitNuffield Department of Population HealthUniversity of OxfordOxfordUnited Kingdom
- MRC Population Health Research UnitUniversity of OxfordOxfordUnited Kingdom
| | - Zheng Bian
- Chinese Academy of Medical SciencesBeijingChina
| | - Eric Wan
- Clinical Trial Service Unit and Epidemiological Studies UnitNuffield Department of Population HealthUniversity of OxfordOxfordUnited Kingdom
| | - Meng Yang
- Division of Ultrasound DiagnosisPeking Union Medical College HospitalBeijingChina
| | - Liang Wang
- Division of Ultrasound DiagnosisPeking Union Medical College HospitalBeijingChina
| | - Yuexin Chen
- Centre of Vascular SurgeryPeking Union Medical College HospitalBeijingChina
| | | | - Huajun Long
- NCDs Prevention and Control DepartmentLiuyang CDCLiuyangChina
| | | | - Rory Collins
- Clinical Trial Service Unit and Epidemiological Studies UnitNuffield Department of Population HealthUniversity of OxfordOxfordUnited Kingdom
| | - Liming Li
- Chinese Academy of Medical SciencesBeijingChina
- Department of Epidemiology and BiostatisticsSchool of Public HealthPeking University Health Science CenterBeijingChina
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies UnitNuffield Department of Population HealthUniversity of OxfordOxfordUnited Kingdom
| | - Sarah Parish
- Clinical Trial Service Unit and Epidemiological Studies UnitNuffield Department of Population HealthUniversity of OxfordOxfordUnited Kingdom
- MRC Population Health Research UnitUniversity of OxfordOxfordUnited Kingdom
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24
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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25
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Germain DP, Fouilhoux A, Decramer S, Tardieu M, Pillet P, Fila M, Rivera S, Deschênes G, Lacombe D. Consensus recommendations for diagnosis, management and treatment of Fabry disease in paediatric patients. Clin Genet 2019; 96:107-117. [PMID: 30941742 PMCID: PMC6852597 DOI: 10.1111/cge.13546] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/22/2019] [Accepted: 03/25/2019] [Indexed: 12/17/2022]
Abstract
Fabry disease (FD), a rare X‐linked disease, can be treated with bi‐monthly infusion of enzyme replacement therapy (ERT) to replace deficient α‐galactosidase A (AGAL‐A). ERT reduces symptoms, improves quality of life (QoL), and improves clinical signs and biochemical markers. ERT initiation in childhood could slow or stop progressive organ damage. Preventative treatment of FD from childhood is thought to avoid organ damage in later life, prompting a French expert working group to collaborate and produce recommendations for treating and monitoring children with FD. Organ involvement should be assessed by age 5 for asymptomatic boys (age 12‐15 for asymptomatic girls), and immediately for children diagnosed via symptoms. The renal, cardiac, nervous and gastrointestinal systems should be assessed, as well as bone, skin, eyes, hearing, and QoL. The plasma biomarker globotriaosylsphingosine is also useful. ERT should be considered for symptomatic boys and girls with neuropathic pain, pathological albuminuria (≥3 mg/mmol creatinine), severe GI involvement and abdominal pain or cardiac involvement. ERT should be considered for asymptomatic boys from the age of 7. Organ involvement should be treated as needed. Early diagnosis and management of FD represents a promising strategy to reduce organ damage, morbidity and premature mortality in adulthood.
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Affiliation(s)
| | - Alain Fouilhoux
- Metabolic Diseases Unit, HFME University Hospital Lyon, Lyon, France
| | - Stéphane Decramer
- Paediatric Department, Inserm U1048, Toulouse University Hospital, Toulouse, France
| | - Marine Tardieu
- Paediatric Department, Tours University Hospital, Toulouse, France
| | - Pascal Pillet
- Paediatric Department, Bordeaux University Hospital Pellegrin, Bordeaux, France
| | - Marc Fila
- Department of Paediatric Nephrology-Montpellier University, Arnaud de Villeneuve Hospital, Montpellier, France
| | - Serge Rivera
- Department of Paediatric Neurology, Bayonne Hospital, Bayonne, France
| | - Georges Deschênes
- Department of Paediatric Nephrology, Paris University Hospital Robert Debré, Paris, France
| | - Didier Lacombe
- Department of Medical Genetics, CHU Bordeaux INSERM U1211, Université de Bordeaux, Bordeaux, France
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26
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Krysztofiak H, Młyńczak M, Małek ŁA, Folga A, Braksator W. Left ventricular mass is underestimated in overweight children because of incorrect body size variable chosen for normalization. PLoS One 2019; 14:e0217637. [PMID: 31141818 PMCID: PMC6541472 DOI: 10.1371/journal.pone.0217637] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 05/15/2019] [Indexed: 01/20/2023] Open
Abstract
Background Left ventricular mass normalization for body size is recommended, but a question remains: what is the best body size variable for this normalization—body surface area, height or lean body mass computed based on a predictive equation? Since body surface area and computed lean body mass are derivatives of body mass, normalizing for them may result in underestimation of left ventricular mass in overweight children. The aim of this study is to indicate which of the body size variables normalize left ventricular mass without underestimating it in overweight children. Methods Left ventricular mass assessed by echocardiography, height and body mass were collected for 464 healthy boys, 5–18 years old. Lean body mass and body surface area were calculated. Left ventricular mass z-scores computed based on reference data, developed for height, body surface area and lean body mass, were compared between overweight and non-overweight children. The next step was a comparison of paired samples of expected left ventricular mass, estimated for each normalizing variable based on two allometric equations—the first developed for overweight children, the second for children of normal body mass. Results The mean of left ventricular mass z-scores is higher in overweight children compared to non-overweight children for normative data based on height (0.36 vs. 0.00) and lower for normative data based on body surface area (-0.64 vs. 0.00). Left ventricular mass estimated normalizing for height, based on the equation for overweight children, is higher in overweight children (128.12 vs. 118.40); however, masses estimated normalizing for body surface area and lean body mass, based on equations for overweight children, are lower in overweight children (109.71 vs. 122.08 and 118.46 vs. 120.56, respectively). Conclusion Normalization for body surface area and for computed lean body mass, but not for height, underestimates left ventricular mass in overweight children.
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Affiliation(s)
- Hubert Krysztofiak
- Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
- National Centre for Sports Medicine, Warsaw, Poland
- * E-mail:
| | - Marcel Młyńczak
- Warsaw University of Technology, Faculty of Mechatronics, Institute of Metrology and Biomedical Engineering, Warsaw Poland
| | - Łukasz A. Małek
- Faculty of Rehabilitation, Józef Piłsudski University of Physical Education, Warsaw, Poland
| | | | - Wojciech Braksator
- Department of Sports Cardiology and Noninvasive Cardiovascular Imaging, 2nd Medical Faculty, Medical University of Warsaw, Warsaw, Poland
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27
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Hope KD, Zachariah JP. Predictors and Consequences of Pediatric Hypertension: Have Advanced Echocardiography and Vascular Testing Arrived? Curr Hypertens Rep 2019; 21:54. [PMID: 31134437 DOI: 10.1007/s11906-019-0958-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW Pediatric hypertension is relatively common and associated with future adult hypertension. Elevated blood pressure in youth predicts future adult cardiovascular disease and blood pressure control can prevent progression of pediatric kidney disease. However, pediatric blood pressure is highly variable within a given child and among children in a population. RECENT FINDINGS Therefore, modalities to index aggregate and cumulative blood pressure status are of potential benefit in identifying youth in danger of progression from a risk factor of subclinical phenotypic alteration to clinically apparent event. In this review, we advocate for the health risk stratification roles of echocardiographically assessed cardiac remodeling, arterial stiffness assessment, and assessment by ultrasound of arterial thickening in children and adolescents with hypertension.
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28
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Abstract
The lifespan of children with advanced chronic kidney disease (CKD), although improved over the past 2 decades, remains low compared with the general pediatric population. Similar to adults with CKD, cardiovascular disease accounts for a majority of deaths in children with CKD because these patients have a high prevalence of traditional and uremia-related risk factors for cardiovascular disease. The cardiovascular alterations that cause these terminal events begin early in pediatric CKD. Initially, these act to maintain hemodynamic homeostasis. However, as the disease progresses, these modifications are unable to sustain cardiovascular function in the long term, leading to left ventricular failure, depressed cardiorespiratory fitness, and sudden death. In this review, we discuss the prevalence of the risk factors associated with cardiovascular disease in pediatric patients with CKD, the pathophysiology that stimulates these changes, the cardiac and vascular adaptations that occur in these patients, and management of the cardiovascular risk in these patients.
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Affiliation(s)
- Donald J Weaver
- Division of Nephrology and Hypertension, Levine Children's Hospital, Charlotte, NC
| | - Mark Mitsnefes
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
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29
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Kelly A, Gidding SS, Walega R, Cochrane C, Clauss S, Townsend RR, Xanthopoulos M, Pipan ME, Zemel BS, Magge SN, Cohen MS. Relationships of Body Composition to Cardiac Structure and Function in Adolescents With Down Syndrome are Different than in Adolescents Without Down Syndrome. Pediatr Cardiol 2019; 40:421-430. [PMID: 30386863 PMCID: PMC6399030 DOI: 10.1007/s00246-018-2014-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 10/19/2018] [Indexed: 12/14/2022]
Abstract
Median survival in Down syndrome (DS) is 60 years, but cardiovascular disease risk and its markers such as left ventricular mass (LVM) have received limited attention. In youth, LVM is typically scaled to height2.7 as a surrogate for lean body mass (LBM), the strongest predictor of LVM, but whether this algorithm applies to DS, a condition which features short stature, is unknown. To examine the relationships of LVM and function with height, LBM, and moderate-to-vigorous physical activity(MVPA) in DS, DS youth aged 10-20 years, and age-, sex-, BMI-, race-matched nonDS controls underwent echocardiography for LVM, ejection fraction (EF), and left ventricular diastolic function (measured as E/E'); dual-energy X-ray absorptiometry (DXA)-measured LBM; accelerometry for MVPA. (DS vs. nonDS median [min-max]): DS had lower height (cm) (144.5 [116.7-170.3] vs. 163.3 [134.8-186.7]; p < 0.0001); LBM (kg) (33.48 [14.5-62.3] vs 41.8 [18.07-72.46], p < 0.0001); and LVM (g) (68.3 [32.1-135] vs 94.0 [43.9-164.6], p < 0.0001); similar EF (%) (65 [54-77] vs 64 [53-77], p = 0.59); and higher E/E' (8.41 [5.54-21.4] vs 5.81 [3.44-9.56], p < 0.0001). In height2.7-adjusted models, LVM was lower in DS (β = - 7.7, p = 0.02). With adjustment for LBM, LVM was even lower in DS (β = - 15.1, p < 0.0001), a finding not explained by MVPA. E/E' remained higher in DS after adjustment for age, height, HR, SBP, and BMI (β = 2.6, p < 0.0001). DS was associated with stiffer left ventricles and lower LVM, the latter magnified with LBM adjustment. Scaling to height2.7, the traditional approach for assessing LVM in youth, may underestimate LVM differences in DS. Whether lower LVM and diastolic function are intrinsic to DS, pathologic, or protective remains unknown.Clinical Trial Registration: NCT01821300.
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Affiliation(s)
- Andrea Kelly
- Division of Endocrinology & Diabetes, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. .,Department of Pediatrics, Perelman School of Medicine of University of Pennsylvania, Philadelphia, PA, USA. .,Division of Endocrinology & Diabetes, Roberts Center for Pediatric Research, Room 14363, 2716 South Street, Philadelphia, PA, 19146, USA.
| | - Samuel S. Gidding
- Samuel S. Gidding M.D., Familial Hypercholesterolemia Foundation, Pasadena, CA
| | - Rachel Walega
- Division of Endocrinology and Diabetes, Center for Translational Science, Children’s National Health System, Washington, D.C
| | - Claire Cochrane
- Division of Endocrinology & Diabetes, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Sarah Clauss
- Division of Cardiology, Children’s National Health System, Washington, D.C
| | - Ray R. Townsend
- Department of Medicine, Perelman School of Medicine of University of Pennsylvania, Philadelphia, PA
| | - Melissa Xanthopoulos
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Mary E. Pipan
- Department of Pediatrics, Perelman School of Medicine of University of Pennsylvania, Philadelphia, PA,Division of Behavioral Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Babette S. Zemel
- Department of Pediatrics, Perelman School of Medicine of University of Pennsylvania, Philadelphia, PA,Division of Gastroenterology, Hepatology, & Nutrition, The Children’s Hospital of Philadelphia
| | - Sheela N. Magge
- Division of Endocrinology and Diabetes, Center for Translational Science, Children’s National Health System, Washington, D.C
| | - Meryl S. Cohen
- Department of Pediatrics, Perelman School of Medicine of University of Pennsylvania, Philadelphia, PA,Division of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, PA
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30
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Díaz A, Zócalo Y, Bia D. Reference Intervals and Percentile Curves of Echocardiographic Left Ventricular Mass, Relative Wall Thickness and Ejection Fraction in Healthy Children and Adolescents. Pediatr Cardiol 2019; 40:283-301. [PMID: 30288599 DOI: 10.1007/s00246-018-2000-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 09/28/2018] [Indexed: 12/19/2022]
Abstract
Despite the clinical utility of echocardiography to measure cardiac target organ injury (TOI) there are scarcities of data about the reference intervals (RIs) and percentiles of left ventricular (LV) mass (LVM) and derived indexes (LVMI and LVMI2.7), relative wall thickness (LVRWT) and ejection fraction (LVEF) from population-based studies in children and adolescents. The aim of this study was to generate reference intervals RIs of LVM and derived indexes (LVMI and LVMI2.7), LVRWT, and LVEF obtained in healthy children, adolescents, and young adults from a South-American population. Echocardiographic studies were obtained in 1096 healthy subjects (5-24 years). Age and sex-specific RIs of LVM, LVMI, LVMI2.7, LVRWT, and LVEF were generated using parametric regression based on fractional polynomials. After covariate analysis (i.e., adjusting by age, body surface area) specific sex-specific RIs were evidenced as necessaries. Age and sex-specific 1st, 2.5th, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97.5th, and 99th percentile and curves were reported and compared with previously reported RIs. RIs showed high concordance and complementarity with what was previously reported for the population of North-American children (0-18 years old). In conclusion, in children and adolescents the interpretation of the LVM, LVMIs, LVRWT, and LVEF RIs requires sex-related RIs. This study provides the largest Argentinean database concerning RIs and percentile curves of LVM, LVMIs, LVRWT, and LVEF as markers of cardiac TOI obtained in healthy children and adolescents. These data are valuable in that they provide RIs values with which data of populations of children, adolescents can be compared.
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Affiliation(s)
- Alejandro Díaz
- Instituto de Investigación en Ciencias de la Salud, UNICEN - CONICET, 4 de Abril 618, 7000, Tandil, Buenos Aires Province, Argentina.
| | - Yanina Zócalo
- Physiology Department, School of Medicine, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Republic University, General Flores 2125, 11800, Montevideo, Uruguay
| | - Daniel Bia
- Physiology Department, School of Medicine, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Republic University, General Flores 2125, 11800, Montevideo, Uruguay
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31
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Krysztofiak H, Młyńczak M, Folga A, Braksator W, Małek ŁA. Normal Values for Left Ventricular Mass in Relation to Lean Body Mass in Child and Adolescent Athletes. Pediatr Cardiol 2019; 40:204-208. [PMID: 30209524 PMCID: PMC6348292 DOI: 10.1007/s00246-018-1982-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 09/01/2018] [Indexed: 01/17/2023]
Abstract
It has been demonstrated that regular sport activity in children leads to physiological changes in the heart including increased left ventricular (LV) myocardial thickness and mass (LVM). The aim of the study was to establish the first specific normal values of LVM for child and adolescent athletes. Parasternal long-axis, 2D-guided echocardiographic measurements were obtained from a group of 791 Caucasian child athletes (age 5-18 years, 58.7% boys). For the preparation of normative data, LVM-for-lean body mass (LBM) reference curves were constructed using the LMS method. Then, a simple correlation plot was constructed to analyse the concordant and discordant indications of left ventricular hypertrophy (LVH), defined as LVM-for-LBM above the 95th percentile, according to the newly created and previously published normative data on LVM-for-LBM in the general population of children. Reference scatter plots of LVM-for-LBM for boys and girls in the analysed group of children practicing sports were presented, showing mean values of LVM and z-scores. The application to the studied group of reference centiles established for the general population of children would lead to false positive misclassification of increased LVH in 5.8% of the girls and 17.0% of the boys. We present the first specific normative data for LV mass in relation to lean body mass in Caucasian children and adolescents engaged in regular sport activities. The application of specific normative data for LV mass results in fewer false positive findings of left ventricular hypertrophy in this group than that of reference values for general paediatric population.
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Affiliation(s)
- Hubert Krysztofiak
- Mossakowski Medical Research Centre, Polish Academy of Sciences, 5 Pawinskiego Street, 02-106, Warsaw, Poland.
- National Centre for Sports Medicine, 78 Pory Str, 02-757, Warsaw, Poland.
| | - Marcel Młyńczak
- Institute of Metrology and Biomedical Engineering, Faculty of Mechatronics, Warsaw University of Technology, 8 Andrzeja Boboli Str, 02-525, Warsaw, Poland
| | - Andrzej Folga
- National Centre for Sports Medicine, 78 Pory Str, 02-757, Warsaw, Poland
| | - Wojciech Braksator
- Department of Sports Cardiology and Noninvasive Cardiovascular Imaging, Second Faculty of Medicine, Medical University of Warsaw, 8 Kondratowicza Str, 03-258, Warsaw, Poland
| | - Łukasz A Małek
- Faculty of Rehabilitation, Józef Piłsudski University of Physical Education, 34 Marymoncka Str, 00-968, Warsaw, Poland
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32
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Blais S, Patenaude J, Doyon M, Bouchard L, Perron P, Hivert MF, Dallaire F. Effect of gestational diabetes and insulin resistance on offspring's myocardial relaxation kinetics at three years of age. PLoS One 2018; 13:e0207632. [PMID: 30462720 PMCID: PMC6248989 DOI: 10.1371/journal.pone.0207632] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 11/02/2018] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Scientific evidence on the long-term impact of gestational diabetes mellitus (GDM) on offspring's myocardial relaxation is scarce. Studies have linked GDM with transient ventricular hypertrophy in newborns resulting in diastolic dysfunction, but long-term assessment is lacking. The main objective of this study was to evaluate myocardial relaxation in 3-year-old children in relation to the degree of insulin resistance of their mother during pregnancy. METHODS We prospectively assessed myocardial relaxation by echocardiography imaging on 106 children at 3 years of age. Subjects were divided into 3 groups [GDM, insulin resistance (IR) and normoglycemic (CTRL)], based on their mother's 75g-OGTT and HOMA-IR results at second trimester screening. We collected information on children adiposity and body size, maternal characteristics and maternal and cord blood measurement of C-peptide and insulin. RESULTS The study population comprised 29 children from GDM mothers, 36 children from IR mothers and 41 CTRL children. Compared to the CTRL group, we found that a higher proportion of children in the IR group and the GDM group met the criteria for impaired myocardial relaxation, but this did not reach statistical significance (odds ratio adjusted for heart rate and body surface area of 1.4 [0.2-9.5] and 3.5 [0.6-20.6], respectively). CONCLUSION We did not detect an increased risk of impaired myocardial relaxation at three years of age in children exposed in-utero to IR and GDM, compared to children from normoglycemic mothers.
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Affiliation(s)
- Samuel Blais
- Department of Pediatrics, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
| | - Julie Patenaude
- Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
- Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Myriam Doyon
- Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
| | - Luigi Bouchard
- Department of Biochemistry, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- ECOGENE-21 Biocluster, Chicoutimi, Quebec, Canada
| | - Patrice Perron
- Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
- Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Marie-France Hivert
- Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
- Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Diabetes Center, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States of America
| | - Frederic Dallaire
- Department of Pediatrics, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
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Krysztofiak H, Małek ŁA, Młyńczak M, Folga A, Braksator W. Comparison of echocardiographic linear dimensions for male and female child and adolescent athletes with published pediatric normative data. PLoS One 2018; 13:e0205459. [PMID: 30308023 PMCID: PMC6181376 DOI: 10.1371/journal.pone.0205459] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 09/25/2018] [Indexed: 02/08/2023] Open
Abstract
Background Application of normative data for echocardiographic measurements to children practicing sports may lead to false positive findings. The aim of the study was to define the normative data of basic echocardiographic measurements for this group and to compare them to the previously published normative data for the pediatric population. Methods Parasternal long-axis 2D-guided echocardiographic measurements were obtained from a group of 791 child athletes (ages 5–18 years). According to the methodology presented previously by Pettersen et al. (2008), the regression equations for basic cardiac dimensions against body surface area were derived and individual Z-scores values were computed, using both Pettersen’s equations and newly derived ones. Results Z-scores computed based on Pettersen’s equations were found to differ significantly from those based on the new equations, for all the analyzed parameters (p<0.001). In agreement analysis, the most pronounced differences were found for the left atrium, interventricular septum and the left ventricular posterior wall. However, in most cases, the indications of abnormality were concordant (91.8%–97.6%); except for the left atrium, where there were 30.8% discordant results. Conclusion The study presents normative data for basic echocardiographic cardiac measurements for children of both sexes practicing varying sporting disciplines and compares them with general pediatric population. Mean values of cardiac dimensions are higher in young athletes, particularly in relation to the left atrium and left ventricular muscle thickness. In most cases, the upper limit of normality observed in the young athletes is confined within the upper limit of the general pediatric population.
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Affiliation(s)
- Hubert Krysztofiak
- Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
- National Centre for Sports Medicine, Warsaw, Poland
- * E-mail:
| | - Łukasz A. Małek
- Faculty of Rehabilitation, Józef Piłsudski University of Physical Education, Warsaw, Poland
| | - Marcel Młyńczak
- Institute of Metrology and Biomedical Engineering, Faculty of Mechatronics, Warsaw University of Technology, Warsaw Poland
| | | | - Wojciech Braksator
- Departament of Sports Cardiology and Noninvasive Cardiovascular Imaging, 2nd Medical Faculty, Medical University of Warsaw, Warsaw, Poland
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Baker-Smith CM, Flinn SK, Flynn JT, Kaelber DC, Blowey D, Carroll AE, Daniels SR, de Ferranti SD, Dionne JM, Falkner B, Gidding SS, Goodwin C, Leu MG, Powers ME, Rea C, Samuels J, Simasek M, Thaker VV, Urbina EM. Diagnosis, Evaluation, and Management of High Blood Pressure in Children and Adolescents. Pediatrics 2018; 142:peds.2018-2096. [PMID: 30126937 DOI: 10.1542/peds.2018-2096] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
UNLABELLED Systemic hypertension is a major cause of morbidity and mortality in adulthood. High blood pressure (HBP) and repeated measures of HBP, hypertension (HTN), begin in youth. Knowledge of how best to diagnose, manage, and treat systemic HTN in children and adolescents is important for primary and subspecialty care providers. OBJECTIVES To provide a technical summary of the methodology used to generate the 2017 "Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents," an update to the 2004 "Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents." DATA SOURCES Medline, Cochrane Central Register of Controlled Trials, and Excerpta Medica Database references published between January 2003 and July 2015 followed by an additional search between August 2015 and July 2016. STUDY SELECTION English-language observational studies and randomized trials. METHODS Key action statements (KASs) and additional recommendations regarding the diagnosis, management, and treatment of HBP in youth were the product of a detailed systematic review of the literature. A content outline establishing the breadth and depth was followed by the generation of 4 patient, intervention, comparison, outcome, time questions. Key questions addressed: (1) diagnosis of systemic HTN, (2) recommended work-up of systemic HTN, (3) optimal blood pressure (BP) goals, and (4) impact of high BP on indirect markers of cardiovascular disease in youth. Once selected, references were subjected to a 2-person review of the abstract and title followed by a separate 2-person full-text review. Full citation information, population data, findings, benefits and harms of the findings, as well as other key reference information were archived. Selected primary references were then used for KAS generation. Level of evidence (LOE) scoring was assigned for each reference and then in aggregate. Appropriate language was used to generate each KAS based on the LOE and the balance of benefit versus harm of the findings. Topics that could not be researched via the stated approach were (1) definition of HTN in youth, and (2) definition of left ventricular hypertrophy. KASs related to these stated topics were generated via expert opinion. RESULTS Nearly 15 000 references were identified during an initial literature search. After a deduplication process, 14 382 references were available for title and abstract review, and 1379 underwent full text review. One hundred twenty-four experimental and observational studies published between 2003 and 2016 were selected as primary references for KAS generation, followed by an additional 269 primary references selected between August 2015 and July 2016. The LOE for the majority of references was C. In total, 30 KASs and 27 additional recommendations were generated; 12 were related to the diagnosis of HTN, 13 were related to management and additional diagnostic testing, 3 to treatment goals, and 2 to treatment options. Finally, special additions to the clinical practice guideline included creation of new BP tables based on BP values obtained solely from children with normal weight, creation of a simplified table to enhance screening and recognition of abnormal BP, and a revision of the criteria for diagnosing left ventricular hypertrophy. CONCLUSIONS An extensive and detailed systematic approach was used to generate evidence-based guidelines for the diagnosis, management, and treatment of youth with systemic HTN.
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Affiliation(s)
- Carissa M Baker-Smith
- Division of Cardiology, Department of Pediatrics, School of Medicine, University of Maryland, Baltimore, Maryland;
| | | | - Joseph T Flynn
- Division of Nephrology, Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington
| | - David C Kaelber
- Division of General Internal Medicine, Departments of Pediatrics and Population and Quantitative Health Sciences, Case Western Reserve University and Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, Ohio
| | - Douglas Blowey
- University of Missouri-Kansas City, Children's Mercy Kansas City, Children's Mercy Integrated Care Solutions, Kansas City, Missouri
| | - Aaron E Carroll
- Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, Indiana
| | - Stephen R Daniels
- Department of Pediatrics, School of Medicine, University of Colorado, Children's Hospital Colorado, Aurora, Colorado
| | | | - Janis M Dionne
- Division of Nephrology, Department of Pediatrics, University of British Columbia and BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Bonita Falkner
- Departments of Medicine and Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Samuel S Gidding
- Cardiology Division, Nemours Cardiac Center, A. I. duPont Hospital for Children and Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Celeste Goodwin
- National Pediatric Blood Pressure Awareness Foundation, Prairieville, Louisiana
| | - Michael G Leu
- Departments of Pediatrics and Biomedical Informatics and Medical Education, University of Washington, University of Washington Medicine Information Technology Services, and Seattle Children's Hospital, Seattle, Washington
| | - Makia E Powers
- Department of Pediatrics, Morehouse School of Medicine, Atlanta, Georgia
| | | | - Joshua Samuels
- Departments of Pediatrics and Internal Medicine, McGovern School of Medicine, University of Texas, Houston, Texas
| | - Madeline Simasek
- Department of Pediatrics, UPMC Shadyside Family Medicine Residency, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh and School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Vidhu V Thaker
- Department of Medicine, Boston Children's Hospital, Harvard Medical School, Harvard University, Boston, Massachusetts.,Division of Molecular Genetics, Department of Pediatrics, Columbia University Irving Medical Center, Columbia University, New York, New York.,Broad Institute, Cambridge, Massachusetts; and
| | - Elaine M Urbina
- Preventive Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Choudhry S, Salter A, Cunningham TW, Levy PT, Hackett BP, Singh GK, Johnson MC. Risk factors and prognostic significance of altered left ventricular geometry in preterm infants. J Perinatol 2018; 38:543-9. [PMID: 29410539 DOI: 10.1038/s41372-018-0047-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Accepted: 11/23/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Left ventricular (LV) hypertrophy (LVH) predicts adverse cardiac events in adults. We sought to determine the risk factors and prognostic significance of altered LV geometry in preterm infants. STUDY DESIGN In an echocardiographic, single-center, retrospective case-control study we investigated the risk factors and outcomes in patients with altered LV geometry (either increased left ventricular mass index (LVMI) or increased relative wall thickness (RWT)) from a cohort of 503 preterm infants ≤2 kg. RESULT Altered LV geometry was seen in 180 patients and was predicted by postnatal steroids and small for gestational age. Hospital stay was longer in the elevated RWT cases. Altered LV geometry resolved in 129 of the 131 cases with follow-up echocardiogram. Fifteen of 94 patients with elevated RWT died compared to 3/90 controls (P = 0.004). CONCLUSION Altered LV geometry in preterm infants is associated with postnatal steroid use and small for gestational age. Elevated RWT is associated with longer hospital stay and increased mortality.
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Majonga ED, Norrish G, Rehman AM, Kranzer K, Mujuru HA, Nathoo K, Odland JO, Kaski JP, Ferrand RA. Racial Variation in Echocardiographic Reference Ranges for Left Chamber Dimensions in Children and Adolescents: A Systematic Review. Pediatr Cardiol 2018; 39:859-68. [PMID: 29616292 DOI: 10.1007/s00246-018-1873-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 03/22/2018] [Indexed: 12/19/2022]
Abstract
Echocardiography plays a critical role in the assessment of cardiac disease. Important differences in echocardiographically derived cardiac chamber dimensions have been previously highlighted in different population groups in adult studies, but this has not been systematically studied in children, whose body size changes throughout childhood. The aim of this study was to review the distribution of available reference ranges for the left cardiac chamber dimensions in older children and adolescents. The following electronic data bases were searched: Medline, Embase and Web of Science were searched to identify studies which have established echocardiographic reference ranges of left heart parameters in children and adolescents from 1975 to December 2017. There was no geographical limitation. All results were imported into Endnote. Retrieved articles were screened and data extracted by two independent reviewers. A total of 4398 studies were retrieved, with 36 studies finally included in this review. 29 (81%) references were from North America and European (Caucasians) populations, with only one study each from Africa and South America. Two-dimensional and M-mode techniques were the most commonly used echocardiography techniques. There were methodological variations in techniques and normalisation of references. Comparison of selected cardiac measures showed significant differences for interventricular septal thickness among Black African, Indian, German and US American children. Available echocardiographic references cannot be generalised to all settings and therefore, there is need for locally relevant reference ranges. Africa and South America are particularly under-represented. Future studies should focus on developing comprehensive echocardiographic reference ranges for children from different racial backgrounds and should use standardised techniques.
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Abstract
The size, hemodynamics, and function of cardiovascular structures change dramatically from the early fetal life to late adolescence. The principal determinants of cardiovascular dimensions are related to the blood flow needed to meet metabolic demands. This demand is in turn tightly related to body size and body composition, keeping in mind that various tissues may have different metabolic rates. There is no simple model that links cardiac dimensions with a single body size measurement. Consequently, despite abundant scientific literature, few studies have proposed pediatric reference values that efficiently and completely account for the effect of body size. Other factors influence cardiovascular size and function in children, including sex. The influence of sex is multifactorial and not fully understood, but differences in body size and body composition play an important role. We will first review the determinants of cardiovascular size and function in children. We then explore the evaluation and normalization of cardiovascular size and function in pediatric cardiology in relation to the growth of cardiovascular structures during childhood, with a particular focus on sex differences.
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Affiliation(s)
| | - Taisto Sarkola
- University of Helsinki, the Helsinki University Central Hospital/Children's Hospital, Helsinki, Finland
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Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, de Ferranti SD, Dionne JM, Falkner B, Flinn SK, Gidding SS, Goodwin C, Leu MG, Powers ME, Rea C, Samuels J, Simasek M, Thaker VV, Urbina EM. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Pediatrics 2017; 140:peds.2017-1904. [PMID: 28827377 DOI: 10.1542/peds.2017-1904] [Citation(s) in RCA: 1799] [Impact Index Per Article: 257.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
These pediatric hypertension guidelines are an update to the 2004 "Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents." Significant changes in these guidelines include (1) the replacement of the term "prehypertension" with the term "elevated blood pressure," (2) new normative pediatric blood pressure (BP) tables based on normal-weight children, (3) a simplified screening table for identifying BPs needing further evaluation, (4) a simplified BP classification in adolescents ≥13 years of age that aligns with the forthcoming American Heart Association and American College of Cardiology adult BP guidelines, (5) a more limited recommendation to perform screening BP measurements only at preventive care visits, (6) streamlined recommendations on the initial evaluation and management of abnormal BPs, (7) an expanded role for ambulatory BP monitoring in the diagnosis and management of pediatric hypertension, and (8) revised recommendations on when to perform echocardiography in the evaluation of newly diagnosed hypertensive pediatric patients (generally only before medication initiation), along with a revised definition of left ventricular hypertrophy. These guidelines include 30 Key Action Statements and 27 additional recommendations derived from a comprehensive review of almost 15 000 published articles between January 2004 and July 2016. Each Key Action Statement includes level of evidence, benefit-harm relationship, and strength of recommendation. This clinical practice guideline, endorsed by the American Heart Association, is intended to foster a patient- and family-centered approach to care, reduce unnecessary and costly medical interventions, improve patient diagnoses and outcomes, support implementation, and provide direction for future research.
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Affiliation(s)
- Joseph T Flynn
- Dr. Robert O. Hickman Endowed Chair in Pediatric Nephrology, Division of Nephrology, Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington;
| | - David C Kaelber
- Departments of Pediatrics, Internal Medicine, Population and Quantitative Health Sciences, Center for Clinical Informatics Research and Education, Case Western Reserve University and MetroHealth System, Cleveland, Ohio
| | - Carissa M Baker-Smith
- Division of Pediatric Cardiology, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Douglas Blowey
- Children's Mercy Hospital, University of Missouri-Kansas City and Children's Mercy Integrated Care Solutions, Kansas City, Missouri
| | - Aaron E Carroll
- Department of Pediatrics, School of Medicine, Indiana University, Bloomington, Indiana
| | - Stephen R Daniels
- Department of Pediatrics, School of Medicine, University of Colorado-Denver and Pediatrician in Chief, Children's Hospital Colorado, Aurora, Colorado
| | - Sarah D de Ferranti
- Director, Preventive Cardiology Clinic, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Janis M Dionne
- Division of Nephrology, Department of Pediatrics, University of British Columbia and British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Bonita Falkner
- Departments of Medicine and Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Susan K Flinn
- Consultant, American Academy of Pediatrics, Washington, District of Columbia
| | - Samuel S Gidding
- Cardiology Division Head, Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Celeste Goodwin
- National Pediatric Blood Pressure Awareness Foundation, Prairieville, Louisiana
| | - Michael G Leu
- Departments of Pediatrics and Biomedical Informatics and Medical Education, University of Washington, University of Washington Medicine and Information Technology Services, and Seattle Children's Hospital, Seattle, Washington
| | - Makia E Powers
- Department of Pediatrics, School of Medicine, Morehouse College, Atlanta, Georgia
| | - Corinna Rea
- Associate Director, General Academic Pediatric Fellowship, Staff Physician, Boston's Children's Hospital Primary Care at Longwood, Instructor, Harvard Medical School, Boston, Massachusetts
| | - Joshua Samuels
- Departments of Pediatrics and Internal Medicine, McGovern Medical School, University of Texas, Houston, Texas
| | - Madeline Simasek
- Pediatric Education, University of Pittsburgh Medical Center Shadyside Family Medicine Residency, Clinical Associate Professor of Pediatrics, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, and School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Vidhu V Thaker
- Division of Molecular Genetics, Department of Pediatrics, Columbia University Medical Center, New York, New York; and
| | - Elaine M Urbina
- Preventive Cardiology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
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Sgambat K, Clauss S, Moudgil A. Cardiovascular effects of metabolic syndrome after transplantation: convergence of obesity and transplant-related factors. Clin Kidney J 2017; 11:136-146. [PMID: 29423213 PMCID: PMC5798023 DOI: 10.1093/ckj/sfx056] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 05/17/2017] [Indexed: 12/19/2022] Open
Abstract
Children are at increased risk of developing metabolic syndrome (MS) after kidney transplantation, which contributes to long-term cardiovascular (CV) morbidities and decline in allograft function. While MS in the general population occurs due to excess caloric intake and physical inactivity, additional chronic kidney disease and transplant-related factors contribute to the development of MS in transplant recipients. Despite its significant health consequences, the interplay of the individual components in CV morbidity in pediatric transplant recipients is not well understood. Additionally, the optimal methods to detect early CV dysfunction are not well defined in this unique population. The quest to establish clear guidelines for diagnosis is further complicated by genetic differences among ethnic groups that necessitate the development of race-specific criteria, particularly with regard to individuals of African descent who carry the apolipoprotein L1 variant. In children, since major CV events are rare and traditional echocardiographic measures of systolic function, such as ejection fraction, are typically well preserved, the presence of CV disease often goes undetected in the early stages. Recently, new noninvasive imaging techniques have become available that offer the opportunity for early detection. Carotid intima-media thickness and impaired myocardial strain detected by speckle tracking echocardiography or cardiac magnetic resonance are emerging as early and sensitive markers of subclinical CV dysfunction. These highly sensitive tools may offer the opportunity to elucidate subtle CV effects of MS in children after transplantation. Current knowledge and future directions are explored in this review.
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Affiliation(s)
- Kristen Sgambat
- Department of Nephrology, Children's National Medical Center, Washington, DC, USA
| | - Sarah Clauss
- Department of Cardiology, Children's National Medical center, Washington, DC, USA
| | - Asha Moudgil
- Department of Nephrology, Children's National Medical Center, Washington, DC, USA
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Cantinotti M, Kutty S, Franchi E, Paterni M, Scalese M, Iervasi G, Koestenberger M. Pediatric echocardiographic nomograms: What has been done and what still needs to be done. Trends Cardiovasc Med 2017; 27:336-49. [DOI: 10.1016/j.tcm.2017.01.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 01/17/2017] [Accepted: 01/18/2017] [Indexed: 12/29/2022]
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Majonga ED, Rehman AM, McHugh G, Mujuru HA, Nathoo K, Patel MS, Munyati S, Odland JO, Kranzer K, Kaski JP, Ferrand RA. Echocardiographic reference ranges in older children and adolescents in sub-Saharan Africa. Int J Cardiol 2017; 248:409-413. [PMID: 28711335 PMCID: PMC5627581 DOI: 10.1016/j.ijcard.2017.06.109] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 06/27/2017] [Indexed: 12/15/2022]
Abstract
Background Echocardiographic reference ranges are important to identify abnormalities of cardiac dimensions. Reference ranges for children in sub-Saharan Africa have not been established. The aim of this study was to establish echocardiographic z-score references for Black children in sub-Saharan Africa. Methods 282 healthy subjects aged 6–16 years (143 [51%] males) with no known history of cardiac disease were enrolled in the study in Harare, Zimbabwe between 2014 and 2016. Standard M-mode echocardiography was performed and nine cardiac chamber dimensions were obtained. Two non-linear statistical models (gamma weighted model and cubic polynomial model) were tested on the data and the best fitting model was used to calculate z-scores of these cardiac chamber measures. The reference ranges are presented on scatter plots against BSA. Results Normative data for the following cardiac measures were obtained and z-scores calculated: right ventricular diameter at end diastole (RVEDD); left ventricular diameter at end diastole (LVEDD) and systole (LVESD); interventricular septal wall thickness at end diastole (IVSd) and systole (IVSs); left ventricular posterior wall thickness at end diastole (LVPWd) and systole (LVPWs); left atrium diameter at end systole (LA) and tricuspid annular plane systolic excursion (TAPSE). Girls had higher values for BMI and heart rate than boys (p = 0.048 and p = 0.001, respectively). Mean interventricular septal and left ventricular posterior walls thickness was higher than published normal values in predominantly Caucasian populations. Conclusion These are the first echocardiographic reference ranges for children from sub Saharan Africa and will allow accurate assessment of cardiac dimensions in clinical practice.
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Affiliation(s)
- Edith D Majonga
- London School of Hygiene and Tropical Medicine, London, United Kingdom; Biomedical Research and Training Institute, Harare, Zimbabwe.
| | - Andrea M Rehman
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Grace McHugh
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | | | | | | | - Shungu Munyati
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Jon O Odland
- UiT, The Arctic University of Norway, Tromsø, Norway; Department of Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Katharina Kranzer
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Juan P Kaski
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom; Institute of Cardiovascular Science, University College London, United Kingdom
| | - Rashida A Ferrand
- London School of Hygiene and Tropical Medicine, London, United Kingdom; Biomedical Research and Training Institute, Harare, Zimbabwe
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Choudhry S, Salter A, Cunningham TW, Levy PT, Nguyen HH, Wallendorf M, Singh GK, Johnson MC. Normative Left Ventricular M-Mode Echocardiographic Values in Preterm Infants up to 2 kg. J Am Soc Echocardiogr 2017; 30:781-789.e4. [PMID: 28599830 DOI: 10.1016/j.echo.2017.04.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND There is a paucity of normative echocardiographic data in preterm infants. The objectives of this study were to (1) derive left ventricular (LV) M-mode reference values and (2) compare the performance of alternative methods of indexing LV dimensions and LV mass (LVM) in preterm infants. The authors propose that indexing LV measures to weight in preterm infants is a practical approach given the variability associated with tape-measure length measurement in infants. METHODS In this retrospective study, LV M-mode echocardiographic measurements of end-diastolic interventricular septal thickness, end-diastolic LV posterior wall thickness, LV end-diastolic and end-systolic dimensions, LVM, and relative wall thickness were remeasured in 503 hospitalized preterm infants ≤2 kg (372 from a retrospective sample and 131 prospectively enrolled). Measures for all variables did not differ between retrospective and prospective samples, so results were pooled. LV dimensions and LVM indexed for weight, length, and body surface area sex-specific centile curves and corresponding Z scores were generated using Cole's lambda-mu-sigma method. Threshold limits (10th and 80th percentiles) were used to generate the normative range for relative wall thickness. RESULTS Sex-specific centile curves using LVM, end-diastolic interventricular septal thickness, end-diastolic LV posterior wall thickness, LV end-diastolic dimension, and LV end-systolic dimension indexed to weight were similar to the curves generated using length and body surface area. The mean normal range for relative wall thickness was 0.33 (10th percentile, 0.26; 80th percentile, 0.38). CONCLUSIONS From this large cohort of preterm infants, LV M-mode dimension and LVM centile curves indexed to weight were developed as a practical method to assess LV morphology in preterm infants.
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Affiliation(s)
- Swati Choudhry
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Amber Salter
- Department of Biostatistics, Washington University School of Medicine, St. Louis, Missouri
| | - Tyler W Cunningham
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Philip T Levy
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri; Department of Pediatrics, Goryeb Children's Hospital, Morristown, New Jersey
| | - Hoang H Nguyen
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Michael Wallendorf
- Department of Biostatistics, Washington University School of Medicine, St. Louis, Missouri
| | - Gautam K Singh
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Mark C Johnson
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri.
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Woroniecki RP, Kahnauth A, Panesar LE, Supe-Markovina K. Left Ventricular Hypertrophy in Pediatric Hypertension: A Mini Review. Front Pediatr 2017; 5:101. [PMID: 28553631 PMCID: PMC5425592 DOI: 10.3389/fped.2017.00101] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 04/20/2017] [Indexed: 12/17/2022] Open
Abstract
Adults with arterial hypertension (HTN) have stroke, myocardial infarction, end-stage renal disease (ESRD), or die at higher rates than those without. In children, HTN leads to target organ damage, which includes kidney, brain, eye, blood vessels, and heart, which precedes "hard outcomes" observed in adults. Left ventricular hypertrophy (LVH) or an anatomic and pathologic increase in left ventricular mass (LVM) in response to the HTN is a pediatric surrogate marker for HTN-induced morbidity and mortality in adults. This mini review discusses current definitions, clinically relevant methods of LVM measurements and normalization methods, its epidemiology, management, and issue of reversibility in children with HTN. Pediatric definition of LVH and abnormal LVM is not uniformed. With multiple definitions, prevalence of pediatric HTN-induced LVH is difficult to ascertain. In addition while in adults cardiac magnetic resonance imaging is considered "the gold standard" for LVM and LVH determination, pediatric data are limited to "special populations": ESRD, transplant, and obese children. We summarize available data on pediatric LVH treatment and reversibility and offer future directions in addressing LVH in children with HTN.
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Affiliation(s)
- Robert P Woroniecki
- Division of Pediatric Nephrology and Hypertension, Stony Brook Children's Hospital, School of Medicine, Stony Brook, NY, USA
| | | | - Laurie E Panesar
- Division of Pediatric Cardiology, Stony Brook Children's Hospital, School of Medicine, Stony Brook, NY, USA
| | - Katarina Supe-Markovina
- Division of Pediatric Nephrology and Hypertension, Stony Brook Children's Hospital, School of Medicine, Stony Brook, NY, USA
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Ruebner RL, Ng D, Mitsnefes M, Foster BJ, Meyers K, Warady B, Furth SL. Cardiovascular Disease Risk Factors and Left Ventricular Hypertrophy in Girls and Boys With CKD. Clin J Am Soc Nephrol 2016; 11:1962-1968. [PMID: 27630183 PMCID: PMC5108185 DOI: 10.2215/cjn.01270216] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 07/22/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Prior studies suggested that women with CKD have higher risk for cardiovascular disease (CVD) and mortality than men, although putative mechanisms for this higher risk have not been identified. We assessed sex differences in (1) CVD risk factors and left ventricular hypertrophy (LVH), and (2) the relationship of left ventricular mass (LVM) with different measures of body size in children with CKD. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS The study population comprised 681 children with CKD from the Chronic Kidney Disease in Children cohort, contributing 1330 visits. CVD risk factors were compared cross-sectionally by sex. LVH was defined as LVM/height2.7 >95th percentile and LVM relative to estimated lean body mass (eLBM) >95th percentile for age and sex. Differences in LVM by sex were assessed by adjusting for age, weight, height, and eLBM using bivariate and multivariate regression models. RESULTS Girls were less likely to have uncontrolled hypertension (26% versus 38%, P=0.001), had lower diastolic BP z-scores (+0.3 versus +0.6, P=0.001), and had lower prevalence of high triglycerides (38% versus 47%, P=0.03) compared with boys. When LVH was defined by LVM indexed to height, girls had higher prevalence of LVH (16% versus 9%, P=0.01); when LVH was defined by LVM relative to eLBM, prevalence of LVH was similar between girls and boys (18% versus 17%, P=0.92). In regression models adjusting for eLBM, no sex differences in LVM were observed. CONCLUSIONS Despite lack of increased prevalence of CVD risk factors, indexing LVM to height showed a higher proportion of LVH among girls, while estimates of LVH based on eLBM showed no sex differences. Indexing LVM to eLBM may be an alternative to height indexing in children with CKD.
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Affiliation(s)
| | - Derek Ng
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
| | - Mark Mitsnefes
- Division of Nephrology, Department of Pediatrics, Cincinnati Children’s Hospital, Cincinnati, Ohio
| | - Bethany J. Foster
- Department of Pediatrics, Montreal Children’s Hospital, Montreal, Quebec, Canada
| | - Kevin Meyers
- Division of Nephrology, Department of Pediatrics, Children’s Hospital of Philadelphia, and
| | - Bradley Warady
- Division of Nephrology, Department of Pediatrics, Children’s Mercy Hospital, Kansas City, Missouri
| | - Susan L. Furth
- Division of Nephrology, Department of Pediatrics, Children’s Hospital of Philadelphia, and
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania; and
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Marsenic O, Anderson M, Couloures KG. Relationship between Interdialytic Weight Gain and Blood Pressure in Pediatric Patients on Chronic Hemodialysis. Biomed Res Int 2016; 2016:5972930. [PMID: 27843947 DOI: 10.1155/2016/5972930] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 10/10/2016] [Indexed: 11/22/2022]
Abstract
Overhydration is reported to be the main cause of hypertension (HTN) as well as to have no association with HTN in hemodialysis (HD) population. This is the first report of the relationship between interdialytic weight gain (IDWG) and pre-HD blood pressure (BP) in pediatric patients in relation to residual urine output (RUO). We studied 170 HD sessions and interdialytic periods performed during a 12-week period in 5 patients [age 4–17 years, weight 20.8–66 kg, 3 anuric (102 HD sessions), and 2 nonanuric (68 HD sessions)]. BP is presented as systolic BP index (SBPI) and diastolic BP index (DBPI), calculated as systolic or diastolic BP/95th percentile for age, height, and gender. IDWG did not differ (P > 0.05) between anuric and nonanuric pts. There was a positive but not significant correlation between IDWG and both pre-HD SBPI (r = 0.833, P = 0.080) and pre-HD DBPI (r = 0.841, P = 0.074). Pre-HD SBPI (1.01 ± 0.12 versus 1.13 ± 0.18) and DBPI (0.92 ± 0.16 versus 1.01 ± 0.24) were higher in nonanuric patents (P < 0.001 and P < 0.01, resp.). Pre-HD HTN may not be solely related to IDWG and therapies beyond fluid removal may be needed. Individualized approach to HTN management is necessary in pediatric dialysis population.
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Shang Y, Zhang X, Chen L, Leng W, Lei X, Yang Q, Liang Z, Wang J. Assessment of Left Ventricular Structural Remodelling in Patients with Diabetic Cardiomyopathy by Cardiovascular Magnetic Resonance. J Diabetes Res 2016; 2016:4786925. [PMID: 27419144 PMCID: PMC4933864 DOI: 10.1155/2016/4786925] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 04/26/2016] [Indexed: 12/12/2022] Open
Abstract
Background. Diabetic cardiomyopathy (DCM) is always accompanied with alteration of left ventricular structure and function. The aims of this study were to assess the structural remodelling in patients with DCM by cardiovascular magnetic resonance (CMR) and correlation of structural remodelling with severity of DCM. Methods. Twenty-five patients (53.8 ± 8.8 years, 52.0% males) with DCM and thirty-one normal healthy controls (51.9 ± 13.6 years, 45.2% males) were scanned by CMR cine to assess function and structure of left ventricular. Length of diabetic history and results of cardiac echocardiography (E', A', and E'/A') were also measured. Results. Compared with normal controls group, DCM group was associated with significantly increased ratio of left ventricular mass at end diastole to end-diastolic volume (MVR) (P < 0.05) and no significant difference was in mass at end diastole (P > 0.05). The ratio correlated with both length of diabetic history and echocardiographic Doppler tissue imaging E' (all P < 0.05). Conclusions. CMR can be a powerful technique to assess LV remodelling, and MVR may be considered as an imaging marker to evaluate the severity of LV remodelling in patients with DCM.
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Affiliation(s)
- Yongning Shang
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Xiaochun Zhang
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Liu Chen
- Department of Endocrinology, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Weiling Leng
- Department of Endocrinology, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Xiaotian Lei
- Department of Endocrinology, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Qi Yang
- Department of Radiology, Xuanwu Hospital, Beijing 100053, China
| | - Ziwen Liang
- Department of Endocrinology, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
- *Ziwen Liang: and
| | - Jian Wang
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
- *Jian Wang:
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