Abstract
Background: The impact of blood pressure elevation and obesity on cardiac lunction in children and adolescents has not been studied. New non-invasive echo technique, such as Strain (S) (%) and Strain Rate (SR) (l/s) imaging has enhanced our ability to study regional systolic myocardial functions. Methods: In all we studied 150 subjects, 30 untreated hypertensive children (Group H: mean age 124-3 years, 50% males,), 50 obese (BMI > 95th percentile for age and s~0() children (Group O: mean age 114-3 years, 43% males), 40 obese and hypertensive children (Group He: mean age 134-3 years, 56% males), and 30 age sex comparable heallhy children (clrls: mean age 124-3 years, 50% males). All patients underwent slandard echocardiographic sludy and SR imaging evalulioa. Peak systolic SR values were used for INs analysis. Hypertension was defined as office syslolic or diastolic blood pressure >951h percenlile for age, se~ and heighl on at least 2, diflerenl occasions. Results: Group O (294-6 kg/n~) and He (314-6 kg/n~) presented increased BMI compared to ctrls (184-3 kg/n~) and Group H pts (194-2 kg/m2). Systolic blood pressure was higher in Group H (1314-17mmHg) than He (1294-25mmHg) than in ctrls (1204-16 mmHg, p<0.05) and in Group O (1224-15 mmHg, p<0.05). Left venlricular mass corrected for height 2.7 was increased (p<0.01) in pts compared to ctrls, and among pts was significantly (p<0.01) higher in Group He. Global indices el systolic lunction were similar in the 4 groups. Longitudinal deformation properties were significantly reduced in pts (Group O: SR= -1.64-1 ; H: SR= -1.54-0.9; Group He: SR= -1.44-0.8; Clrls: SR= -1.94-0.3), bul in Group He also myocardial radial deformalion properlies (Group He: SR= 1.74-0.9) were significantly reduced compared to clrls (SR= .3.24-1 ) and Group H (SR= 2.94-0.7) and Group O (SR= 2.64-0.9). Right venlricle regional myocardial deformalion properties were comparable Io ctrls in Group H, while in Group O and He were signilicantly reduced (p<0.01 vs ctrls, p<0.01 vs Group H). Both radial and righl ventricular myocardial delormation properties were significantly correlaled Io lasting glycaemia (r=0.70; p<0.01). Conclusions: This study shows thal children with obesity and hypertension have a more severe reduction in myocardial delormation properties involving both radial and longitudinal function as well as right and left ventricular lunction compared to those with one disease or the other. SR imaging may be used as a relevant loci to assess the influence el cardiovascular risk laclors on cardiac lunclion in high-risk children.
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