Detection of early diastolic alterations by Tissue Doppler Imaging in untreated childhood-onset essential hypertension

Abstract

Background Aim of the study was to determine the presence of preclinical diastolic dysfunction in hypertensive children relative to normotensive children by Tissue Doppler Imaging (TDI). Methods We prospectively enrolled children with untreated essential hypertension in absence of any other disease and a matched healthy control group with normal blood pressure (BP); both groups confirmed by clinic BP and a 24 hour ambulatory BP monitoring. Echocardiographic diastolic parameters were determined using spectral transmitral inflow Doppler, flow propagation velocity, TDI, and systolic parameters were determined via midwall shortening fraction and ejection fraction. Results A total of 80 multiethnic children were prospectively enrolled for the study: 46 hypertensive (median age 13 years, 72% males) and 34 control (median age 14 years, 65% males). The only echocardiography parameters which had a statistically significant change compared to the control children, were regional mitral Ea, Aa and the E/Ea ratio by TDI. In comparison to controls, hypertensive children had lower Ea and Aa velocities of anterior and posterior walls and higher lateral wall E/Ea ratio. The decrease in posterior wall Ea and Aa remained significant after adjustment for gender, age, body mass index, ethnicity, and left ventricular hypertrophy on multivariate analysis. The lateral and septal wall E/Ea ratios correlated significantly with fasting serum insulin levels on similar multivariate analysis. Conclusions Decreased regional TDI velocities were seen with preserved left ventricular systolic function even when other measures of diastolic dysfunction remained unchanged in untreated hypertensive children. Hypertension and serum insulin levels had strong associations with preclinical diastolic alterations in children.

Left Ventricular Hypertrophy Phenotype in Childhood‐Onset Essential Hypertension

“…Therefore, it is not surprising that even in children with EH in our study, obesity plays a role in the development of LVH. In our previous study, after multivariate analysis, we demonstrated that LV compliance indices correlated significantly with serum insulin levels in nondiabetic children with EH . Obesity along with elevated triglycerides was seen in association with LVH in our current study, indicating a potential role of cardiometabolic phenotype in the development of LVH among children with EH.…”

“…Primary hypertension or essential hypertension (EH) can lead to cardiovascular changes in childhood, including subclinical hypertensive cardiomyopathy, aortopathy and vasculopathy . Left ventricular (LV) hypertrophy (LVH), as demonstrated by an increase in LV mass (LVM) on echocardiography, is the most common surrogate marker of end‐organ damage from EH on echocardiography.…”

Tissue Doppler Imaging in Echocardiography: Value and Limitations

“…In another study, 417 patients admitted with heart failure were followed for a median of 306 days [70]; an increase in E/ e' was linearly associated with increased all-cause mortality. E/e' ratio is also useful in detecting early LV DD in patients with untreated early onset hypertension and hyperinsulinaemia [71].…”

Indeks Massa Ventrikel Kiri dengan Disfungsi Diastole pada Pasien Konsentrik Penyakit Jantung Hipertensi

“…Disfungsi diastole terjadi bersamaan dengan fibrosis dan iskemia miokardium pada hipertensi sistemik kronik sehingga disfungsi diastole ventrikel kiri dengan restriksi pengisian ventrikel kiri dianggap sebagai tanda hypertensive heart disease. 18 Penilaian hipertrofi ventrikel kiri dilakukan dengan mengukur ketebalan dinding merupakan faktor sangat penting dalam menilai keparahan disfungsi ventrikel kiri. 16 Indeks massa ventrikel kiri mencerminkan beratnya hipertrofi ventrikel kiri sehingga secara teoritis IMVK mencerminkan tingkat disfungsi diastole.…”