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Left Ventricular Measurements and Strain in Pediatric Patients Evaluated for Systemic Hypertension and the Effect of Adequate Anti-hypertensive Treatment

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Abstract

Pediatric hypertension (HTN) is an epidemic that is associated with HTN in adulthood and adverse cardiovascular outcomes. We hypothesized that children with HTN would have left ventricular (LV) hypertrophy and abnormal LV global longitudinal strain (GLS) on echocardiogram and that these values would differ by weight, race, and HTN treatment. Data were collected from first visits to the HTN Program from 12/2011 to 9/2018, excluding patients with cardiac disease or heart transplantation. LV measurements including LV mass index (LVMI), LV GLS, and diastolic indices were compared between groups. Multivariable logistic regression was used to identify risk factors for an abnormal LVMI. There were 212 patients with an interquartile age range of 13–18 years. On univariate analysis, LVMI was higher in hypertensive, obese, and African American patients. LV strain was less negative in obese and African American patients. Adequately treated patients with HTN had a higher LVMI and a higher E/e′ ratio compared to patients with no HTN. On multivariate analysis, only obesity was associated with an LVMI ≥ 95th percentile (OR 2.9, 95% CI 1.4, 5.8). LVMI is higher in hypertensive, obese, and African American patients; however, in the multivariate analysis, obesity was the only independent risk factor for an abnormal LVMI. LVMI was still higher in those adequately treated for HTN compared to patients without HTN, possibly due to concomitant obesity. Future studies should focus on subclinical changes in LV performance seen in obese and hypertensive patients and the impact on long-term health.

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Data are available for sharing upon request.

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Abbreviations

LV:

Left ventricle

BMI:

Body mass index

HTN:

Hypertension

CVRF:

Cardiovascular risk factors

ABPM:

Ambulatory blood pressure monitoring

PWT:

Posterior wall thickness of the left ventricle

LVMI:

Left ventricular mass index

EF:

Ejection fraction

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Funding

The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Division of Cardiology, Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA

    Michelle Kaplinski, Fang Liu, Craig Tinker, Nina C. Laney, Melodee Mendoza, Meryl S. Cohen, Kevin Meyers & Shobha S. Natarajan

  2. Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Heather Griffis

  3. Division of Cardiology, Department of Pediatrics, Lucile Packard Children’s Hospital, Stanford University, 750 Welch Road, Suite 325, Palo Alto, CA, 94340, USA

    Michelle Kaplinski

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  1. Michelle Kaplinski
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  2. Heather Griffis
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  3. Fang Liu
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  4. Craig Tinker
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  5. Nina C. Laney
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  9. Shobha S. Natarajan
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Correspondence to Michelle Kaplinski.

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All subjects provided informed consent under a protocol approved by the CHOP Institutional Review Board for the Protection of Human Subjects.

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This work was previously presented as an abstract: Kaplinski M, Griffis H, Liu F, Tinker C, Laney NC, Mendoza M, Cohen MS, Meyers K, Natarajan S. Echocardiographic Findings in Pediatric Patients Evaluated for Systemic Hypertension. [Abstract] American Heart Association Scientific Sessions 2017, Anaheim, CA.

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Kaplinski, M., Griffis, H., Liu, F. et al. Left Ventricular Measurements and Strain in Pediatric Patients Evaluated for Systemic Hypertension and the Effect of Adequate Anti-hypertensive Treatment. Pediatr Cardiol 43, 155–163 (2022). https://doi.org/10.1007/s00246-021-02706-x

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  • DOI: https://doi.org/10.1007/s00246-021-02706-x

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