Ventricular Mass In Children Research Articles

Corrigendum to: Incidence of left ventricular hypertrophy in children with kidney disease: impact of method of indexation of left ventricular mass

doi:10.1093/ejechocard/jep211 This recent paper on the impact of method of indexation of left ventricular mass in children included reference to a …

Inappropriate left ventricular mass in children and young adults with chronic renal insufficiency

Increased left ventricular (LV) mass (M) in children with chronic renal insufficiency (CRI) might represent an adaptive mechanism to compensate for increased workload. We hypothesized that in children with CRI, pre-dialysis, values of left ventricular mass (LVM) exceed compensatory values for individual cardiac load. Complete anthropometric characteristics, biochemical profile and echocardiograms were obtained for 33 children with CRI, pre-dialysis (age 1-23 years, mean 12.2 +/- 5.0 years), and 33 age- and gender-matched healthy controls. LV dimensions, wall thicknesses and volume were measured. Endocardial and midwall shortening, ejection fraction, LVM, LVM index, relative wall thickness, circumferential wall stress and excess LVM (as ratio of observed LVM to value predicted from body size, gender and cardiac workload) were analysed. Patients with CRI showed higher values of LVM index, resulting in higher prevalence of LV hypertrophy (36.3% vs 9%, P < 0.05). The ratio of excess LVM was greater in patients with CRI than in healthy controls (126 +/- 19% and 103 +/- 13%, respectively, P < 0.001). LV ejection fraction, midwall fractional shortening and stress-corrected midwall shortening were lower in patients with CRI than in controls. We concluded that, in children with CRI, the values of LVM are higher than those needed to sustain individual cardiac load than in healthy controls, a condition associated with LV hypertrophy and reduced systolic performance.

Effects of Body Size and Body Fatness on Left Ventricular Mass in Children and Adolescents: Project HeartBeat!

Left ventricular mass (LVM) is a strong predictor of cardiovascular disease in adults. Available study findings on effects of body fatness on LVM in children are inconsistent. Understanding the impact of body fat on LVM in children may help prevent excessive LVM through measures to reduce overweight and obesity. Healthy children (n=678) aged 8, 11, and 14 years at baseline were examined at 4-month intervals for up to 4 years (1991-1995); 4608 valid measurements of LVM were obtained with M-mode echocardiography. A multilevel linear model was used for analysis. The impact of body size was examined by adding separately nine body-size indicators to a basic LVM-gender-age model. The impact of body fatness was tested by introducing four body-fatness indicators into the nine models, yielding 36 models. All body-size indicators showed strong, positive effects on LVM. In models containing weight or body surface area (measuring both fat-free and fat contributions to body size), additional effects of body fatness were negative; in models containing fat-free mass (FFM) or height (both measuring body size independent of body fat), increased body fatness was related to a significant increase in LVM. For example, in models with FFM as a body-size indicator, a 1-SD increase in percent body fat or fat mass was related to a 5.4- or 7.2-g increase in LVM, respectively. Effects of body size on LVM attributable to fat-free body mass can be distinguished from those attributable to fat body mass; both are independent, positive predictors, but the former is the stronger determinant. When a body-size indicator not independent of body fat is used as a predictor, effects of fat-free body mass and fat body mass are forced to relate to the same indicator; because their magnitudes are estimated to be equal, the effect of fat body mass is overestimated. Thus, when an additional body-fatness indicator is included in the prediction of LVM, the additional estimated effect related to the indicator appears to be negative.

Blood Aldosterone-to-Renin Ratio, Ambulatory Blood Pressure, and Left Ventricular Mass in Children

To assess the blood aldosterone-to-renin ratio (ARR) and its relationship to ambulatory blood pressure (ABP) and left ventricular mass (LVM) in children. A cross-sectional clinical study was conducted in 102 children (71.6% African American; 62.7% male) ranging in age from 7 to 18 years (mean, 13.6 years; median, 14 years). ABP (24-hour monitoring) was expressed as blood pressure index (BPI; mean blood pressure/95th percentile by sex and height). LVM was measured by echocardiography and expressed as an index (LVMI = g/height [m](2.7)). Regression analyses were used to estimate associations. African-American children had significantly lower serum aldosterone concentration and plasma renin activity compared with European-American children (aldosterone: 5.9 ng/dL vs 11.4 ng/dL, P < .0001; renin: 1.6 ng/mL/hour vs 2.8 ng/mL/hour, P = .01). However, ARR was not significantly different by race. ARR was not associated with 24-hour ABP but was significantly associated with LVMI (beta = 0.4 g/m(2.7); P = .02) after adjustment for the ratio of 24-hour urine Na to creatinine excretion, body mass index z- score, and ABP index. The data indicated a significant association between ARR and LVMI, but not ABP, in children, suggesting early cardiac remodeling associated with a high ARR.

Increased left ventricular mass in children with autosomal dominant polycystic kidney disease and borderline hypertension

Autosomal dominant polycystic kidney disease (ADPKD) is a common hereditary condition that may be diagnosed in utero. Our goal was to evaluate symptoms of ADPKD in children, including left ventricular mass index (LVMI), renal volume, renal function and microalbuminuria in relation to systolic and diastolic blood pressure. Eighty-five children were stratified by blood pressure into three cohorts: hypertensive (95th percentile and over), borderline hypertensive (75-95th percentile) and normotensive (75th percentile and below). There were no differences in gender, age, height, renal function, or microalbuminuria between the groups. Both the hypertensive and borderline hypertensive children had a significantly higher LVMI than normotensive children, with no significant difference between hypertensive and borderline hypertensive groups. There was a significant correlation between renal volume and both systolic and diastolic blood pressures in all subjects. Renal volume in hypertensive children was significantly larger than in the borderline hypertensive group, with no significant difference between normotensive and borderline hypertensive groups. These findings show that an increase in LVMI may be detected earlier than an increase in renal volume in children with ADPKD and borderline hypertension, suggesting that close monitoring of cardiac status is indicated in these children.

Ambulatory Blood Pressure and Increased Left Ventricular Mass in Children at Risk for Hypertension

To relate ambulatory blood pressure (ABP) to cardiac target organ measurement in children at risk for primary hypertension (HTN). Left ventricular mass index (LVMI) and ABP were measured concomitantly in children (6 to 18 years) at risk for hypertension using a cross-sectional study design. LVMI showed a significant positive correlation with 24-hour systolic blood pressure (SBP) load, SBP index (SBPI), and standard deviation score (SDS). When subjects were stratified by LVMI percentile, there were significant differences in SBP load, 24-hour SBPI, and 24-hour SSDS. The odds ratio (OR) of having elevated LVMI increased by 54% for each incremental increase of SDS in 24-hour SSDS after controlling for race and BMI (OR = 1.54, unit = 1 SDS, CI = 1.1, 2.15, P = .011) and increased by 88% for each increase of 0.1 in BPI (OR = 1.88, CI = 1.03, 3.45, P = .04). Subjects with stage 3 HTN had significantly greater mean LVMI compared with normal subjects (P = .002 by ANOVA; LMVI, 31.6 +/- 7.9 versus 39.5 +/- 10.4). As systolic ABP variables increase, there is greater likelihood for increased LVMI. Staging based on ABPM allows assessment of cardiovascular risk in children with primary hypertension.

Comparison between fundamental and second‐harmonic imaging echocardiography for calculation of left ventricular mass in children

In adults, calculation of left ventricular mass (LVM) has been shown to give higher values when based on M-mode measurements obtained by the second-harmonic imaging (SHI) technique than with the older fundamental imaging (FI) technique. No information is available in paediatric subjects. This study, therefore, compares LVM calculated from measurements obtained with SHI and FI in 14 children, aged 6.9-13.0 years. M-mode tracings were obtained in accordance with American Society of Echocardiography (ASE) recommendations. Three experienced sonographers performed measurements on each subject with both SHI and FI. The mean value was used in all calculations. LVM was calculated according to ASE convention and indexed by body surface area. LVM mean values were 58.9 +/- 9.7 g m(-2) for SHI and 57.8 +/- 8.2 g m(-2) for FI (P = 0.45). This preliminary study in a small group of paediatric subjects demonstrates no systematic differences between FI and SHI modalities in the calculation of LVM. The likely explanation is that the left ventricular endocardial border is usually well visualized with SHI as well as with FI in children.

Ambulatory blood pressure monitoring predicts increased left ventricular mass in children with primary hypertension

OR-19 Key Words: Left Ventricular Mass, Ambulatory Blood Pressure Monitoring, Essential Hypertension

Relation of insulin resistance and body composition to left ventricular mass in children

Relation of insulin resistance and body composition to left ventricular mass in children

Changes in left ventricular mass in children and adolescents during chronic dialysis.

Left ventricular hypertrophy (LVH) is an independent risk factor for cardiac mortality in adults with end-stage renal disease (ESRD). It is prevalent in pediatric patients on chronic dialysis. The objectives of this study were to evaluate left ventricular mass (LVM) in children and adolescents at the initiation of dialysis and to assess its changes during chronic dialysis therapy. In this longitudinal analysis, 29 patients aged 4-18 years had an echocardiographic evaluation within 90 days of starting dialysis therapy and a follow-up study at least 6 months later. LVH was defined as LVM index (g/m2.7) > 95th percentile for normal children and adolescents. On the initial echocardiogram 20 of 29 (69%) patients had LVH and 24 patients (83%) had abnormal LV geometry (38% eccentric LVH, 31% concentric LVH, and 14% concentric remodelling). Patients with LVH were more likely to be on antihypertensive medications (16/20) than patients without LVH (3/9) (P = 0.005). Repeat echocardiogram, performed after 10 +/- 3 months on chronic dialysis, showed no significant difference in the mean LVM index (49.6 +/- 17.5 g/m2.7 and 49.7 +/- 16.1 g/m2.7, respectively) or in the prevalence of LVH or LV geometric pattern. However, 14 of 29 patients had a progressive increase in LVM index and 15 patients had regression. Multiple regression analysis showed that baseline LVM index (P = 0.005) and interval change in indexed systolic blood pressure (P = 0.027) were independent predictors for LVM index changes. In summary, LVH and abnormal LV geometry are already prevalent in children and adolescents with renal failure at the time of initiation of dialysis therapy, indicating that LVH develops during the pre-ESRD course. Early intervention to control blood pressure may be an important factor to improve and prevent progression of LVH in pediatric patients with ESRD.

Echocardiographic evaluation of cardiac functions and left ventricular mass in children with malnutrition.

This study was undertaken to assess the left ventricular mass (LV Mass) and systolic and diastolic functions of the left ventricle in children with protein energy malnutrition (PEM). Thirty children, aged between 2 months and 2 years with PEM (four kwashiorkor, seven marasmic- kwashiorkor, 19 marasmus), and 17 healthy, age-matched children, using Doppler echocardiography were studied. The mean LV Mass in the patients was lower than that in the controls (14.5 +/- 5.2 vs 19.8 +/- 4.7 g, P < 0.05). However, the LV Mass/body surface area was not different in the patients with PEM and in the control group (52 +/- 9.2 vs 53.9 +/- 8.2g/m(2), P > 0.05), indicating that LV Mass was reduced in proportion to decrease in body size in malnutrition. Left ventricular septal and posterior wall thickness in PEM were also lower than that in the controls, and the most significant reduction in the LV Mass, septal and posterior wall thickness were found in the kwashiorkor group. Cardiac output was reduced in proportion to decrease in body size in the patient group (1.6 +/- 0.5 vs 2.1 +/- 0.8 L/min, P < 0.05), therefore cardiac index was not significantly different between the patients and the control subjects (5.9 +/- 1.4 vs 5.7 +/- 1.6 L/min/m(2), P > 0.05). Systolic function indices including ejection fraction, fractional shortening, and diastolic function indices were not significantly different in the groups. We demonstrated that LV Mass and cardiac output were reduced in proportion to decrease in body size in patients with PEM, and LV systolic and diastolic functions were preserved in atrophic hearts.

Weights at birth and in early infancy, systolic pressure, and left ventricular structure in subjects aged 8 to 24 years.

The objective of this study was to determine whether systolic pressure and left ventricular mass in children, adolescents, and young adults are related to fetal and infant growth. Blood pressure measurements and M-mode echocardiography were performed in 210 subjects aged 8 to 24 years whose information on weights at birth and in early infancy, written by physicians, was obtained from the children's health record booklets. Systolic pressure, adjusted for sex and current height or for sex, current age, weight, and height, was the highest in subjects with low birth weight. No association was observed between systolic pressure and weight at either 9 months or 2 years. Left ventricular mass, adjusted for sex and current height or for sex, current age, weight, and height, increased with decreasing weight at 9 months or 2 years, independent of systolic pressure. Increased ventricular mass associated with reduced infant growth was concentric, resulting from a proportionate thickening of the posterior wall and interventricular septum. Left ventricular mass was not related to birth weight. These findings were observed in both sexes and in all age subgroups and were independent of gestational age, birth order, and parental risk factors. This study supports the hypothesis that systolic pressure and left ventricular mass might be partly determined during fetal life and early infancy. The mechanisms that underlie the associations of blood pressure and left ventricular structure with weights at birth and in early infancy should be studied thoroughly.

Fat-free mass as a determinant of left ventricular mass in children: The Muscatine Study.

To assess the relationship of somatic growth to heart growth, associations were examined among body composition, blood pressure, androgens, sexual maturation, and left ventricular mass (LVM) during early puberty in 123 children, 7-12 years of age. All subjects underwent anthropometry, random-zero blood pressure measurements, hormone determination of androgens, physician's examination to determine sexual maturation, and echocardiographic examinations. Subjects then repeated these procedures 1 year later. Data were examined cross-sectionally (year 1, year 2) and longitudinally (Δ = year 2 minus year 1). The strongest correlations with LVM were among weight and fat-free mass (FFM) (r = 0.60 to 0.83). In males, cross-sectional predictors of LVM were FFM and stage of sexual maturation (r2 = 0.49 to 0.65). Δ LVM was best predicted in males by Δ testosterone and Δ weight (r2 = 0.22). In females, FFM was the strongest cross-sectional predictor of LVM (r2 = 0.70). Δ LVM was best predicted in females by Δ FFM and Δ height (r2 = 0.27). When males and females were pooled, gender did not predict LVM in any of the models. The results suggest that FFM is an important predictor of LVM in circumpubertal children. Boys and girls do not significantly differ in LVM once normalized for FFM. © 1996 Wiley-Liss, Inc.

Effect of lean body mass, fat mass, blood pressure, and sexual maturation on left ventricular mass in children and adolescents. Statistical, biological, and clinical significance.

Left ventricular hypertrophy has been established as an independent risk factor for the development of cardiovascular morbidity and mortality. It is clear that left ventricular mass increases during childhood and adolescence with body growth. The extent to which other factors, such as obesity, stage of sexual maturation, and level of blood pressure, determine left ventricular mass has been controversial. The study was a cross-sectional evaluation of the relationship of left ventricular mass determined by echocardiography with lean body mass and fat mass determined by dual-energy x-ray absorptiometry, which is the most valid and reliable method for determination of body composition in children and adolescents. The relationship of left ventricular mass with the stage of sexual maturation and with systolic and diastolic blood pressure was also evaluated. Two hundred one subjects (105 boys, 96 girls; 103 white and 98 black) 6 to 17 years old were studied. Age (r = .72), height (r = .81), weight (r = .84), body surface area (r = .87), sexual maturation (r = .75), lean body mass (r = .86), fat mass (r = .54), systolic BP (r = .58), and diastolic BP (r = .48) were all univariate correlates of left ventricular mass. In a multiple regression analysis, only lean body mass, fat mass, and systolic blood pressure were statistically significant independent correlates of left ventricular mass. Lean body mass alone explained 75% of the variance of left ventricular mass, whereas fat mass and systolic blood pressure explained only 1.5% and 0.5% of the variance, respectively. Lean body mass was the strongest determinant of left ventricular mass in all four race-sex groups. This study provides an opportunity to separate the effects on left ventricular mass of lean body mass resulting from linear growth from those of fat mass resulting from obesity. Lean body mass, fat mass, and systolic blood pressure all have a statistically significant independent association with left ventricular mass, suggesting that all three play an important biological role in determining left ventricular mass. However, fat mass and systolic blood pressure have only a small impact on left ventricular mass. This indicates that fat mass and blood pressure would be expected to be of only minor clinical importance in determining left ventricular mass in normal children and adolescents.

Effect of total adipose weight and systemic hypertension on left ventricular mass in children

To investigate the effect of obesity and hypertension on left ventricular (LV) mass in children, we performed echocardiography and measured the height, weight, and blood pressure of 267 healthy children (145 boys and 122 girls) aged 12 years. The percentage of body fat was estimated using bioelectric impedance to derive the total adipose weight and lean body weight. End-diastolic measurements of LV parameters were obtained from M-mode echocardiograms. The LV mass was calculated by using the formula of Devereux et al. A strong positive correlation was demonstrated between non-normalized LV mass and height or other measures of body size. Systolic blood pressure was weakly correlated with non-normalized LV mass in boys. The impact of height on LV mass differed between boys and girls. Thus, different allometric formulas to normalize the LV mass for height were determined, using the height to the 3.1 and 1.9 powers for boys and girls, respectively. Regression analysis revealed that only total adipose weight affected the normalized LV mass, and that the effect of total adipose weight was greater in girls than in boys. The obese children had a significantly greater normalized LV mass than the nonobese children. The increase in the LV mass due to obesity appeared to be eccentric, because of the lack of an association between the indices of obesity and relative wall thickness. Our data indicate that appropriate normalization of LV mass is necessary for each study population, and that LV hypertrophy due to obesity begins in childhood.

Evaluation of left ventricular mass in children with left-sided congenital diaphragmatic hernia

To evaluate left ventricular (LV) mass in children with left-sided congenital diaphragmatic hernia (CDH), we retrospectively examined the echocardiographic data available on all newborn infants with a diagnosis of CDH between April 1989 and May 1993. Adequate data for evaluation were available for 20 of 31 patients with left-sided CDH and no significant congenital heart disease. Left ventricular mass was determined from two-dimensional echocardiograms by an area-length method. Findings were compared with a control group that consisted of neonates with other causes of pulmonary hypertension. Patients with left-sided CDH had a significantly lower indexed LV mass than control subjects (1.96 gm/kg +/- 0.59 vs 2.84 gm/kg +/- 0.41; p = 0.0001). Additionally, children with left-sided CDH who required extracorporeal membrane oxygenation before repair (n = 7) had a significantly lower indexed LV mass than those patients who did not require extracorporeal membrane oxygenation before repair (1.53 gm/kg +/- 0.50 vs 2.20 gm/kg +/- 0.52; (p = 0.007). Infants who survived (n = 13) had an indexed LV mass of 2.09 gm/kg +/- 0.58 vs 1.64 gm/kg +/- 0.58 in those who died (p = 0.07). We conclude that the LV mass index in children with left-sided CDH is significantly lower than in children with other causes of pulmonary hypertension in the newborn period. Evaluation of LV mass in neonates with left-sided CDH may help predict the need for extracorporeal support before surgical repair, and may help indicate overall prognosis.

Predictors of blood pressure and left ventricular mass in the young: the Hypertension in Pregnancy Offspring Study.

The present study evaluates potential predictors for the future blood pressure and left ventricular mass in children. Fifty-two children were studied at mean age 12.6 +/- 1.5 years and reexamined after 5.6 years. Thirty-six children were born to mothers who had hypertension during pregnancy and 16 children were born after normotensive pregnancies by mothers who remained normotensive at follow-up. Blood pressure was measured at rest and during physical exercise. Left ventricular mass was calculated from M-mode echocardiography, and erythrocyte sodium and potassium concentrations were determined. A stepwise multiple linear regression analysis was used to predict subsequent blood pressure and left ventricular mass. Final systolic blood pressure was best explained by initial systolic blood pressure, erythrocyte potassium concentration, gender, and erythrocyte sodium concentration. Final diastolic blood pressure was best explained by erythrocyte potassium concentration. Gender and initial left ventricular mass were predictors of left ventricular mass at follow-up. This prospective study corroborates previous findings that blood pressure measured in children predicts their future blood pressure. Furthermore, an independent inverse relationship between childhood erythrocyte potassium concentration and adolescent blood pressure is demonstrated. Male gender and an early increased left ventricular mass are independent predictors of an increased left ventricular mass in adolescents.

Five-year follow-up of blood pressure and left ventricular mass in children with different maternal histories of hypertension

To follow the changes in blood pressure and echocardiographically determined left ventricular mass in offspring of mothers who had hypertension during pregnancy. Longitudinal study with a 5-year follow-up. Nineteen offspring of mothers who had hypertension during pregnancy, and sustained hypertension at follow-up 7-12 years after term, were examined, by blood pressure measurement and M-mode echocardiography, at a mean age of 12.8 years (range 10.6-16.4) and were re-examined 5.6 years later. For comparison, 17 children born to mothers who had hypertension during pregnancy, but were normotensive at follow-up, were also examined. A control group of children born following a normotensive pregnancy was also recruited. Comparisons were made by analysis of variance among the three groups. At the initial examination systolic blood pressure was significantly higher in the children born to mothers who had hypertension during pregnancy and were hypertensive at follow-up. This difference persisted in the adolescents at follow-up. No differences among the three groups in echocardiographically determined left ventricular mass were seen, either at the initial examination or at follow-up. There was a significant correlation between left ventricular masses determined 5 years apart (r = 0.53, P < 0.001). The present longitudinal study demonstrates that offspring of mothers with hypertension during pregnancy, that was sustained at follow-up, have higher blood pressure than controls. Children with different maternal histories of hypertension maintain their rank with regard to left ventricular mass during adolescence.

Blood pressure and left ventricular mass in children with different maternal histories of hypertension: the Hypertension in Pregnancy Offspring Study.

To study blood pressure and echocardiographically determined left ventricular mass in children born to mothers who had been hypertensive during the pregnancy and to assess the influence of a maternal factor for hypertension on blood pressure and left ventricular mass. Blood pressure was measured and M-mode echocardiography was performed in 42 children (aged 10.6-16.4 years) born to mothers who had been hypertensive during the pregnancy. For comparison, a control group of 17 children born after a normotensive pregnancy was used. Children born to mothers who had had a hypertensive pregnancy and who showed sustained hypertension during a follow-up, had higher systolic (P < 0.001) and diastolic (P < 0.05) blood pressure. No differences in left ventricular mass were seen. There was a significant correlation between left ventricular mass and systolic blood pressure (r = 0.40; P < 0.01). In multivariate analyses both systolic and diastolic blood pressure were independently related to a familial factor for hypertension, whereas left ventricular mass was not related to a familial factor for hypertension. Children born after a hypertensive pregnancy have higher blood pressure than children born after a normotensive pregnancy. A familial factor for hypertension was correlated with blood pressure, but not left ventricular mass in the children studied.

Elevated blood pressure profile and left ventricular mass in children and young adults with autosomal dominant polycystic kidney disease.

Twelve children (< 15 yr) and 12 young adults with autosomal dominant polycystic kidney disease (ADPKD) confirmed by ultrasonography and 24 nonaffected individuals matched for age, sex, and body surface area were examined with ambulatory blood pressure monitoring and echocardiography. All patients and controls had normal renal function (median serum creatinine, 0.85 mg/dL; range, 0.5 to 1.1). In children, daytime and nighttime blood pressures were not significantly different from those of controls; the median left ventricular mass index (in grams per square meter) was higher in patients (66.6 g/m2) than in controls (61.3 g/m2; P < 0.002), although all values remained within the normal range. In young adults with ADPKD, mean arterial blood pressure was significantly higher than that in controls both during daytime (98.3 mm Hg; range, 74 to 126 versus 90.6 mm Hg; range, 73 to 116; P < 0.006) and during nighttime (83.2 mm Hg; range, 66.5 to 125 versus 79.0 mm Hg; range, 63 to 91; P < 0.05). In parallel, the median left ventricular mass index was significantly higher in young adults (81.8 g/m2; range, 62 to 174 versus 64.3 g/m2; range, 52 to 102; P < 0.02). The results document that ambulatory daytime and nighttime blood pressures and left ventricular mass indices are higher in asymptomatic carriers of the ADPKD trait compared with controls, although most values are still within the normal range.