Ventricular Mass In Children Research Articles

Weight status change during four years and left ventricular hypertrophy in Chinese children.

It is well-established that overweight/obesity is a major risk factor for left ventricular hypertrophy (LVH) in childhood. However, it is still unclear if reversing from overweight/obesity to normal weight is associated with decreased LVH in children. This study aimed to examine the association between weight status change during four years and LVH among Chinese children based on a prospective cohort study. Data were obtained from the Huantai Childhood Cardiovascular Health Cohort Study in China. A total of 1,178 children without LVH at baseline (mean age: 8.3 years) were included in this study. According to weight status [normal weight or overweight (including obesity)] at baseline (2017) and follow-up (2021), children were divided, based on sex- and age-adjusted body mass index (BMI), into four groups: persistent normal weight (normal weight at both baseline and follow-up), incident overweight (normal weight at baseline but overweight at follow-up), reversal to normal weight (overweight at baseline but normal weight at follow-up), persistent overweight (overweight at both baseline and follow-up). After adjustment for potential confounding factors, children with incident overweight (n = 114, 30.63 ± 4.74 g/m2.7) and those with persistent overweight (n = 363, 31.56 ± 6.24 g/m2.7) had higher left ventricular mass index (LVMI) at the end of the follow-up period than those with persistent normal weight (n = 632, 28.46 ± 7.64 g/m2.7), while those who reversed from overweight to normal weight had a non-significantly lower LVMI (n = 69, 28.51 ± 4.28 g/m2.7). Compared to children with persistent normal weight, those with persistent overweight [odds ratio (OR) = 5.14, 95% confidence interval (CI) = 3.33-7.95] and those with incident overweight (OR = 3.34, 95% CI = 1.77-6.30) had an increased risk of LVH. The risk of LVH tended to decrease, although not significantly, in those who reversed from overweight to normal weight (OR = 0.76, 95% CI = 0.22-2.55). Our findings demonstrate a positive association between overweight and left ventricular mass in children and suggest that LVH in childhood could be attenuated by weight loss.

Stricter Blood Pressure Control Is Associated With Lower Left Ventricular Mass in Children After Kidney Transplantation: A Longitudinal Analysis of the 4C-T Study.

We assessed the effect of blood pressure (BP) control on left ventricular mass index (LVMI) and left ventricular hypertrophy (LVH). Ninety-six patients (64 males) ≥9 months post-kidney transplantation from the 4C-T (Cardiovascular Comorbidity in Children with Chronic Kidney Disease and Transplantation) study were analyzed longitudinally (mean follow-up, 2.6±1.3 years). Cumulative systolic blood pressure (SBP)/diastolic BP exposure was calculated as a time-averaged area under the curve and categorized: ≤50th, 50th to ≤75th, 75th to ≤90th, and >90th percentile (pct). We performed adjusted linear and logistic mixed models for LVMI and LVH, respectively. At baseline, LVMI was 49.7±12.7g/m2.16 with 64% (n=61) kidney transplantation recipients displaying LVH. Compared with patients with cumulative SBP exposure >90th pct, patients with cumulative SBP of 50th to ≤75th showed a significant LVMI reduction of -5.24g/m2.16 (P=0.007). A similar tendency was seen for cumulative SBP≤50th (β=-3.70 g/m2.16; P=0.067), but patients with cumulative SBP of 75th to ≤90th pct showed no reduction. A post hoc analysis in patients with cumulative SBP≤75th revealed that median SBP exposure was at 57.5th pct. For cumulative diastolic BP, a significant LVMI reduction was seen in all 3 categories ≤90th pct compared with patients >90th pct. Patients with cumulative SBP of ≤50th or 50th to ≤75th pct showed 79% or 83% lower odds of developing LVH, respectively. Patients with cumulative diastolic BP ≤50th showed a tendency of 82% lower odds for LVH (95% CI, 0.03-1.07). Stricter BP control led to regression of LVMI and LVH. Our data suggest a BP target below the 60th pct, which needs to be substantiated in a randomized controlled trial.

Effects of blood pressure percentile, body mass index, and race on left ventricular mass in children.

To evaluate the association of systolic blood pressure percentile, race, and body mass index with left ventricular hypertrophy on electrocardiogram and echocardiogram to define populations at risk. This is a retrospective cross-sectional study design utilising a data analytics tool (Tableau) combining electrocardiogram and echocardiogram databases from 2003 to 2020. Customized queries identified patients aged 2-18 years who had an outpatient electrocardiogram and echocardiogram on the same date with available systolic blood pressure and body measurements. Cases with CHD, cardiomyopathy, or arrhythmia diagnoses were excluded. Echocardiograms with left ventricle mass (indexed to height2.7) were included. The main outcome was left ventricular hypertrophy on echocardiogram defined as Left ventricle mass index greater than the 95th percentile for age. In a cohort of 13,539 patients, 6.7% of studies had left ventricular hypertrophy on echocardiogram. Systolic blood pressure percentile >90% has a sensitivity of 35% and specificity of 82% for left ventricular hypertrophy on echocardiogram. Left ventricular hypertrophy on electrocardiogram was a poor predictor of left ventricular hypertrophy on echocardiogram (9% sensitivity and 92% specificity). African American race (OR 1.31, 95% CI = 1.10, 1.56, p = 0.002), systolic blood pressure percentile >95% (OR = 1.60, 95% CI = 1.34, 1.93, p < 0.001), and higher body mass index (OR = 7.22, 95% CI = 6.23, 8.36, p < 0.001) were independently associated with left ventricular hypertrophy on echocardiogram. African American race, obesity, and hypertension on outpatient blood pressure measurements are independent risk factors for left ventricular hypertrophy in children. Electrocardiogram has little utility in the screening for left ventricular hypertrophy.

Association of Sleep Quality With Greater Left Ventricular Mass in Children Aged 9 to 11 Years.

Research has consistently found associations between sleep characteristics and cardiovascular disease risk in children, adolescents, and adults. Although primarily investigated in clinical samples (e.g., in those with sleep disorders), greater left ventricular mass is associated with poor sleep quality in nonclinical adult populations as well; however, this has not been evaluated in children or adolescents. Our study aim was to consider the relationship between objectively measured sleep characteristics and left ventricular mass in children. We assessed sleep and cardiac structure in a biracial sample of 9- to 11-year-old children (n = 176; 41% White, 59% Black; 50% female). Sleep was assessed with actigraphy for five nights. Cardiac dimensions were assessed using echocardiography. After adjusting for covariates, we found that poor sleep quality was associated with significantly greater left ventricular mass (β = 0.13, t(167) = 2.14, p = .034, Cohen d = 0.16, for activity during sleep; β = 0.15, t(167) = 2.43, p = .016, Cohen d = 0.18, for sleep fragmentation). Other cardiac dimensions (namely, relative wall thickness and right ventricular dimension) were also significantly associated with sleep characteristics. Notably, associations did not differ as a function of sex or race. The present findings are novel and unique because no prior reports have systematically documented the association between poor sleep quality with potentially detrimental cardiac remodeling in a nonclinical sample of children. However, the novelty and importance of these findings require additional research for confirmation.

Association of blood pressure and left ventricular mass in children from the PROC cohort study

Objective: To explore the association between blood pressure (BP) and the left ventricular mass (LVM) in children aged 6-8 years. Methods: The participants were from the community-based census-like design child cohort on sensitization, puberty, obesity and cardiovascular risk (PROC) conducted in six public non-boarding primary schools in Shunyi District, Beijing. Repeated three measurements on anthropometrical, M-mode and 2-dimensional (2D) echocardiographic imaging (2D/M ECHO) and blood biochemical assay, and BP measurements were carried out at baseline and follow-up from October 2018 to June 2019. A total of 1 659 children who had repeated BP measurements and cardiac structure information were included in this study. The average value of last two measurements of BP was determined as BP value for analysis. Formula recommended by Devereux was used to calculate the mass of left ventricle. Robust linear regression models were used to explore the association between BP and LVM in different groups. Results: The average age of all patients was (7.10±0.29) years old, including 832 boys (50.15%). Of all, 83.54% (1 386/1 659) were grouped as normal BP with average LVM (58.54±13.33) g, and 16.46% (273/1 659) as elevated BP group with LVM (63.84±15.78) g (P<0.001). The LVM of the normal BP group was lower than elevated BP group in overall participants, boys and girls (P<0.005). Univariate analysis showed that systolic BP was associated with LVM in overall, boys and girls (P<0.001) respectively. While diastolic BP was associated with LVM in overall and girls (P<0.03). Multivariable analysis indicated that the associations between systolic BP and LVM were observed in overall, boys and girls (P<0.05) with the β (95%CI)=0.14 (0.08, 0.21), 0.18 (0.08, 0.27) and 0.12 (0.03, 0.22), respectively. However, the associations of diastolic BP and LVM were not significant. Conclusion: Systolic BP is highly associated with LVM and elevated BP could increase the LVM in children. Boys with elevated BP present a larger LVM and might indicate higher risk of left ventricular hypertrophy in adulthood.

Abstract 15047: Effects of Blood Pressure Percentile, Body Mass Index, and Race on Left Ventricular Mass in Children

Introduction: Childhood hypertension, obesity, and left ventricular hypertrophy (LVH) are risk factors for premature cardiovascular events in adulthood, particularly among minorities. In children, race and body mass index (BMI) have been shown to be independently associated with LVH, with conflicting data on the association of systolic blood pressure (SBP) level with risk of LVH and utility of ECG in assessing LVH. This study looks at the association of SBP percentile, race, and BMI with LVH on electrocardiogram (ECG) and echocardiogram (echo) to define populations at risk. Methods: This is a retrospective cross-sectional study design utilizing a data analytics tool (Tableau) combining ECG and echo databases from 2003-2020. Customized queries identified patients ages 2-18 years old who had an outpatient ECG and echo on the same date with available SBP and body measurements. Cases with congenital heart disease, cardiomyopathy, or arrhythmia diagnoses were excluded. Echos with left ventricle mass (indexed to height 2.7 ) were included. The main outcome was LVH on echo defined as LV mass index greater than the 95 th percentile for age. Results: In a cohort of 13,926 patients, 6.9% of studies had LVH on echo. SBP percentile &gt; 90% has a sensitivity of 36% and specificity of 82% for LVH on echo. LVH on ECG was a poor predictor of LVH on echo (9% sensitivity and 92% specificity). African American race (OR 1.31, 95% CI = 1.11, 1.55, p=.001), SBP percentile &gt; 95% (OR=1.64, 95% CI = 1.37, 1.95, p &lt;.001), and higher body mass index (OR= 7.43, 95% CI = 6.44, 8.55, p &lt;.001) were independently associated with LVH on echo. Figure 1 shows the prevalence of LVH by African American race, obesity, and SBP. Conclusions: African American race, obesity, and hypertension are independent risk factors for LVH in children. Outpatient ECG has low utility in screening for LVH.

Body Fat Distribution, Overweight, and Cardiac Structures in School-Age Children: A Population-Based Cardiac Magnetic Resonance Imaging Study.

BackgroundAdiposity is associated with larger left ventricular mass in children and adults. The role of body fat distribution in these associations is not clear. We examined the associations of body fat distribution and overweight with cardiac measures obtained by cardiac magnetic resonance imaging in school‐age children.Methods and ResultsIn a population‐based cohort study including 2836 children, 10 years of age, we used anthropometric measures, dual‐energy X‐ray absorptiometry, and magnetic resonance imaging to collect information on body mass index, lean mass index, fat mass index, and abdominal visceral adipose tissue index. Indexes were standardized by height. Cardiac measures included right and left ventricular end‐diastolic volume, left ventricular mass, and mass‐to‐volume ratio as a marker for concentricity. All body fat measures were positively associated with right and left ventricular end‐diastolic volumes and left ventricular mass, with the strongest associations for lean mass index (all P<0.05). Obese children had a 1.12 standard deviation score (95% CI, 0.94–1.30) larger left ventricular mass and a 0.35 standard deviation score (95% CI, 0.14–0.57) higher left ventricular mass‐to‐volume ratio than normal weight children. Conditional on body mass index, higher lean mass index was associated with higher right and left ventricular end‐diastolic volume and left ventricular mass, whereas higher fat mass measures were inversely associated with these cardiac measures (all P<0.05).ConclusionsHigher childhood body mass index is associated with a larger right and left ventricular size. This association is influenced by higher lean mass. In childhood, lean mass may be a stronger determinant of heart growth than fat mass. Fat mass may influence cardiac structures at older ages.

Diagnostic Accuracy of Electrocardiographic Criteria for Left Ventricular Hypertrophy in Thalassemia Syndrome

We compared the diagnostic accuracy of electrocardiographic (ECG) criteria for left ventricular hypertrophy (LVH) in 119 randomly selected from 400 patients with thalassemia major treated at the Department of Child Health, Medical School, University of Indonesia, Jakarta. Echocardiographically derived left ventricular hypertrophy (EchoLVH), both for body surface area (BSA)-indexed and height-indexed, served as the gold standard. There were 57 girls and 62 boys available, ranging in age from 5 to 27 years. ECG criteria for LVH was detected in 23 outof119 patients, while echo-LVH was detected in 47 patients if BSA-indexed LVH was used, or 22 patients if height-indexed LVH was used. The sensitivity and specificity of ECG-LVH were 25.5 and 84.7% respectively if BSA indexed LVH was used as gold standard, or 36.4% and 84.5%, respectively, when height indexed echo-LVH was used. It is concluded that ECG criteria for LVH has a low sensitivity and hjgh specificity in detecting increased left ventricular mass in children with thalassemia major.

Factors associated with reduction of left ventricular mass in children on peritoneal dialysis.

This study aimed to investigate sensitive factors involved in left ventricular mass reduction in children with end-stage renal disease (ESRD) undergoing peritoneal dialysis. Thirty-five subjects on peritoneal dialysis were enrolled. Two successive echocardiographic and clinical data for each subject were obtained. Blood pressure and left ventricular mass index (LVMI) were indexed through a division with the normal 95th percentile value. Differences in numeric data between two datasets were calculated. The mean age was 12.9±4.6years. Predictors of left ventricular hypertrophy and its persistence were systolic blood pressure index (P=0.019 and P=0.046) and E' velocity (P=0.035 and P=0.031) in univariate analysis. However, differences in these predictors between the datasets were not related to the change in indexed LVMI. Reduction in indexed LVMI was correlated to a reduction of indexed left atrial volume (R=0.638, P=0.001), trans-mitral A velocity (R=0.443, P=0.011), and serum blood urea nitrogen level (R=0.372, P=0.028) and an elevation of haemoglobin level (R=-0.374, P=0.027). The extent of circulating volume expansion is potentially the main predictive factor for change of LVMI, because the volume dependent diastolic functional variables correlate to the change of LVMI. Further study with a large number of ESRD children including a group under fluid volume control is needed to investigate the role of volume expansion on the change of LVMI.

Obesity is Associated with Increased Left Ventricular Mass in Children

Introduction: Obesity is a global program that is increasing worldwide and associates with high morbidity and mortality. Increase left ventricular mass is a target organ damage that is related to increase in blood pressure. Some evidence suggests that obesity is an independent risk factor for the development of increase left ventricular mass. th percentile, overweight defined as BMI between 85 th to 94 th percentile and normal body weight defined as BMI between 5 th to 84 th percentiles According to the BMI obtained, the study sample was then divided into two subgroups; Normal weight for age group and overweight obese group. Systolic and diastolic left ventricular mass index were assessed and measured with 2D echocardiography along with the ejection fraction percentages. Results: Only 59 children (24 males = 40.68% and 35 females = 59.32) were included and the sample were divided into two groups (normal body weight group which constitutes 42.37% of the sample and obese/overweight group which constitutes the remainder 57.63%).The mean (SD) of LV mass index in systole g/m2 was statistically significantly greater in the Obese/Overweight group 82.70 (21.86) compared to the Normal body weight group 69.85 (16.64), t(57) = 2.481 and p = 0.016. The mean difference was 12.85 with (95% CI: 2.48 to 23.21). The mean (SD) of LV mass index in diastole g/m2 was statistically significantly greater in the Obese/Overweight group 61.57 (15.72) compared to the Normal body weight group 52.05 (15.69), t(57) = 2.309 and p = 0.025. The mean difference was 9.51 with (95% CI: 1.26 to 17.76). In the last decade, the incidence of obesity has increased worldwide in the youth population and is most likely related to changes in lifestyle and dietary habits with an increase in the consumption of unhealthy food (5). This trend has become a mounting public health concern across the globe. In the western hemisphere and in the U.S. in particular, 31.7% of children are considered to be overweight and 16.9% are considered obese (6). In comparison, the prevalence of overweight, obese and severely obese children in Saudi Arabia is 23.1%, 9.3% and 2%, respectively (7). In this vulnerable population, an increased BMI is associated with many cardiac disorders that primarily involve atherosclerotic changes. This is particularly evident in the pediatric age group with BMI values above the 97 th percentile. Additionally, pulmonary diseases, such as obstructive sleep apnea and reactive airway disorders, are common presentations in obese children compared

Obesity and left ventricular mass in children

Background Obesity has negative effects on cardiac function during growth leading to increased heart size and mass, as a result of higher stroke volume and cardiac output.Objective To assess for a relationship between obesity and left ventricular mass (LVM) in children, as well as to assess for a correlation between the duration of obesity and LVM.Methods This cross-sectional study was conducted from October 2011 until February 2012 in Medan and included 30 obese and 30 normal weight children, aged 6 to 13 years. All subjects underwent complete echocardiography examinations to assess LVM and other left ventricular parameters. The Devereux formula was used to measure LVM.Results During the study, 65 children underwent echocardiography, but 5 were subsequently excluded. The left ventricular dimensions in the obese group were significantly higher compared to normal weight group with regards to interventricular septum at end diastole (IVSd), interventricular septum at end systole (IVSS), left ventricular internal diameter at end diastole (LVIDd), left ventricular internal diameter at end systole (LVIDs), left ventricular posterior wall thickness at end diastole (LVPWd), left ventricular mass (LVM), and left ventricular mass index (LVMI) (P=0.0001). Duration of obesity and LVM had a moderate, positive correlation (r=0.407).Conclusion There is significantly higher LVM in the obese group than in the normal weight group. The duration of obesity had a moderate, positive correlation to LVM.

Obesity and left ventricular mass in children

Obesity and left ventricular mass in children

Waist circumference to height ratio and left ventricular mass in children and adolescents

Waist circumference to height ratio, a measure of central obesity, is a better predictor of cardiovascular risk than body mass index in the paediatric population. Increased left ventricular mass secondary to obesity and hypertension increases the risk for death and cardiovascular disease in adults. Similar data on left ventricular mass are lacking among young patients with central obesity, as defined by waist circumference/height. The present study evaluates left ventricular mass in young patients with central obesity as defined by waist circumference/height. A total of 156 patients, 2- to 20-years old, without evidence of structural heart disease were studied. As the left ventricular mass is related to age and gender, 52 patients with central obesity - waist circumference/height ⩾0.55 - were randomly matched for age and gender with 52 patients at risk for central obesity - waist circumference/height ⩾0.5 to <0.55 - and 52 patients with no central obesity - waist circumference/height <0.5. The left ventricular mass parameters measured by echocardiography were compared across the three groups. Patients with central obesity had significantly (p<0.05) increased Z scores for left ventricular mass, left ventricular mass/height2.7, and left ventricular mass/height1.7 compared with patients at risk for central obesity and patients with no central obesity. Z scores for left ventricular mass were higher among patients at risk for central obesity compared with patients with no central obesity. Left ventricular mass data of the present study support maintaining an ideal waist circumference/height <0.5. Aggressive efforts to identify and manage patients with central obesity are warranted.

Relationship of FGF23 to indexed left ventricular mass in children with non-dialysis stages of chronic kidney disease.

The aim of this study was to evaluate the association of serum intact fibroblast growth factor 23 (FGF23) concentrations with indexed left ventricular mass in children with non-dialysis stages 3-5 of chronic kidney disease (CKD). The study cohort comprised 83 children (51 boys; mean age 12.1 ± 3.2 years) with a mean estimated glomerular filtration rate (eGFR) of 32.3 ± 14.6 ml/min/1.73 m(2) who underwent clinic and ambulatory blood pressure measurement (ABPM), echocardiography and evaluation of biochemical markers of CKD-associated mineral bone disease. The mean left ventricular mass index (LVMI) was 35.9 ± 8.5 g/m(2.7) (± standard deviation), with 30 (36.1 %) children showing left ventricular hypertrophy (LVH), all eccentric, as defined using age-specific criteria. For all subjects, the mean FGF23 concentration was 142.2 ± 204.4 ng/l and the normalised distribution following log transformation was 1.94 ± 0.39. There was significant univariate correlation of LVMI with GFR, body mass index (BMI) z-score and calcium intake, but not with 24-h systolic ABPM z-score, log intact parathyroid hormone or log FGF23. On multivariate analysis following adjustment for confounders, only elemental calcium content (g/kg/day) estimated from prescribed calcium-based phosphate binder dose (β = 154.9, p < 0.001) and BMI z-score (β = 2.397, p = 0.003) maintained a significant positive relationship with LVMI (model r (2) = 0.225). We observed no significant relationship of FGF23 with LVMI. Larger studies in children are needed to clarify the roles of calcium-containing phosphate binders and FGF23 with LV mass and their roles in the evolution of the development of adverse cardiovascular outcomes.

Association of clearance of middle- and large-molecular-weight substance with arterial stiffness and left ventricular mass in children receiving renal replacement therapy.

The prominent cause of mortality in children receiving dialysis treatment is cardiovascular diseases. Risk factors related to chronic renal disease, are effective in the development of cardiovascular diseases. The aim of study was to investigate cardiovascular system (CVS) involvement for functional and structural alterations in children receiving dialysis, and display any association between cardiovascular morbidity and uremic toxins. 20 dialysis patients and 20 healthy controls were included to the study. Clearance of small, middle and large molecular-weight uremic toxins was evaluated in blood samples collected 30 minutes before (D0) and 2 hour after dialysis (D2), and change value was calculated as D0-D2/D0. Cardiovascular involvement was determined by comparing arterial stiffness, carotid intima-media thickness (CIMT) and Left Ventricular Mass Index (LVMI) with the control group. Four patients receiving hemodialysis and two patients in continuous ambulatory peritoneal dialysis (CAPD) group who have significant differences in all functional and structural parameters were detected. Four dialysis patients with detected cardiovascular disease have distinctively lower beta-2 microglobulin and homocysteine clearances compared to the patients with no CVS involvement. The clearance of middle and large molecular-weight substances should be closely monitored in children receiving dialysis.

Correlation between the morning hypertension on ambulatory blood pressure monitoring and the left ventricular mass in children.

PurposeAlthough high morning blood pressure (BP) is known to be associated with the onset of cardiovascular events in adults, data on its effects in children with hypertension are limited. Our retrospective study aimed to define the clinical characteristics of children with morning hypertension (MH) and to determine its associated factors.MethodsWe reviewed 31 consecutive patients with hypertension, confirmed by the ambulatory blood pressure monitoring (ABPM). We divided these patients into 2 groups: the MH group (n=21, 67.7%), morning BP above the 95th percentile for age and height (2 hours on average after waking up) and the normal morning BP group (n=10, 32.3%). We compared the clinical manifestations, laboratory results, and echocardiographic findings including left ventricular hypertrophy (LVH) between the groups.ResultsThe early/atrial (E/A) mitral flow velocity ratio in the MH group was significantly lower than that in the normal morning BP group. In addition, LV mass was higher in the MH group than in the normal morning BP group, although the difference was not statistically significant. The age at the time of hypertension diagnosis was significantly higher in the MH group than in the normal morning BP group (P=0.003). The incidence of hyperuricemia was significantly higher in the MH group than in the normal morning BP group.ConclusionOlder patients and those with hyperuricemia are at higher risk for MH. The rise in BP in the morning is an important factor influencing the development of abnormal relaxation, as assessed by echocardiography. Clinical trials with longer follow-up periods and larger sample sizes are needed to clarify the clinical significance of MH.

Left Ventricular Mass in Children and Adolescents With Elevated Body Mass Index and Normal Waist Circumference

Children and adolescents with elevated body mass index (BMI) who have normal waist circumference (NWC) have a cardiometabolic risk profile similar to normal children. However, there is a lack of adequate information regarding their left ventricular mass (LVM). The present study was undertaken to evaluate LVM in children with elevated BMI with NWC. LVM was assessed by echocardiography in 247 children (age 2 to 19 years) without evidence of heart disease. Data on those who had elevated BMI with NWC (group 1, n = 80) were compared with matched normal controls with normal BMI who had NWC (group 2, n = 80) and children with elevated BMI with increased waist circumference (IWC; group 3, n = 87). Correlations, t tests, and linear regressions were used for statistical testing. LVM in children with elevated BMI with NWC was not significantly different from normal controls (97.6 ± 44.4 vs 100.7 ± 47.9 g, p = 0.6713, respectively); however, it was significantly less than that in subjects with elevated BMI who also had IWC (97.6 ± 44.4 vs 114.5 ± 47.8 g, p = 0.0193, respectively). Similar to normal controls, those subjects with elevated BMI with NWC had a stronger correlation between LVM and lean body mass (R(2) = 0.86 and 0.86, respectively) than subjects with elevated BMI with IWC (R(2) = 0.75). In conclusion, children with elevated BMI with NWC appear to have a similar LVM profile as children with normal BMI with NWC. The present study emphasizes the importance of measuring waist circumference in children with elevated BMI.

Congenital Diaphragmatic Hernia: Not Quite There Yet

Congenital Diaphragmatic Hernia: Not Quite There Yet

Blood Pressure Control and Left Ventricular Mass in Children with Chronic Kidney Disease

Heart disease is a major cause of death in young adults with chronic kidney disease (CKD). Left ventricular hypertrophy (LVH) is common and is associated with hypertension. The aims of this study were to evaluate whether there is a relationship between LVH and BP in children with CKD and whether current targets for BP control are appropriate. In this single-center cross-sectional study, 49 nonhypertensive children, (12.6 ± 3.0 years, mean GFR 26.1 ± 12.9 ml/min per 1.73 m²) underwent echocardiographic evaluation and clinic and 24-hour ambulatory BP monitoring. LVH was defined using age-specific reference intervals for left ventricular mass index (LVMI). Biochemical data and clinic BP for 18 months preceding study entry were also analyzed. The mean LVMI was 37.8 ± 9.1 g/m²·⁷, with 24 children (49%) exhibiting LVH. Clinic BP values were stable over the 18 months preceding echocardiography. Patients with LVH had consistently higher BP values than those without, although none were overtly hypertensive (> 95th percentile). Multiple linear regression demonstrated a strong relationship between systolic BP and LVMI. Clinic systolic BP showed a stronger relationship than ambulatory measures. Of the confounders evaluated, only elemental calcium intake yielded a consistent, positive relationship with LVMI. LVMI was associated with systolic BP in the absence of overt hypertension, suggesting that current targets for BP control should be re-evaluated. The association of LVMI with elemental calcium intake questions the appropriateness of calcium-based phosphate binders in this population.

Improvement of left ventricular mass with antihypertensive therapy in children with hypertension

There is paucity of data on the regression of left ventricular hypertrophy (LVH) in hypertensive children. This study assessed the effects of antihypertensive therapy on left ventricular mass in children with and without LVH. Medical records of hypertensive patients who had a baseline and follow-up echocardiogram (echo 1, echo 2) were reviewed. Fifteen of 22 treated patients had LVH at echo 1. Enalapril alone or combined was used in 21/22 cases. Echo 2 was performed at a mean interval of 15 +/- 7 months. The LVH group showed significant decrease in systolic blood pressure z-score (SBPZ) (2.89 +/-1.61 to 1.40 +/- 1.19; p=0.01), diastolic blood pressure z-score (DBPZ) (1.44 +/- 0.90 to 0.26 +/- 0.82; p<0.001), and LV mass index (LVMI) (56.2 +/- 12.50 to 43.7 +/- 8.30; p=0.001), but no significant change in body mass index z-score (BMIZ) (1.79 +/- 0.75 to 1.69 +/- 0.69; p=0.74). In the no-LVH group, SBPZ (3.03 +/- 1.68 to 2.27 +/- 1.81; p=0.356), DBPZ (1.00 +/- 0.87 to 0.63 +/- 0.68; p=0.409), BMIZ (1.08 +/- 0.98 to 1.27 +/- 0.89; p=0.672), and LVMI (29.47 +/- 5.51 to 33.89 +/ -3.06;p=0.374) did not change significantly. Simple linear regression demonstrated that the change in LVMI in the combined group had a significant correlation (r=0.477; p=0.025) with the percentage change in SBPZ. This study demonstrates that LVH in hypertensive children improves with effective blood pressure control.