Noninvasive Assessment of Arterial Stiffness and Risk of Atherosclerotic Events in Children

Abstract

Noninvasive assessment of vascular dysfunction in the pediatric population has taken advantage of the development of high-resolution ultrasound techniques. The most frequently used methods are the quantification of flow-mediated endotheliumdependent dilation of the brachial artery and measurement of the intima-media thickening of the carotid artery. Both reduced flow-mediated dilation and increased intima-media thickness have been proven to correlate with late cardiovascular events and/or mortality in adults. As these noninvasive methods can easily be applied in children, there have been recent investigations in high-risk pediatric patients harboring classical cardiovascular risk factors. Endothelial dysfunction and increased thickness of the intima media are currently observed in children with familial hypercholesterolemia, obesity, and type 1 diabetes mellitus. The association of early vascular dysfunction with a known risk factor is an important issue as these anomalies precede the formation of atherosclerotic plaques. Therefore, they may help in stratification of the risk for cardiovascular event and to better tailor therapeutic interventions in at risk children. Finally, these methods have been applied in specific pediatric populations, such as children with end-stage renal disease, chronic parenteral nutrition, HIV infection, and coarctation of the aorta. In these conditions, endothelial dysfunction and vascular remodeling are also present early in life and these data raise new possibilities in the understanding of the pathogenesis of atherosclerosis in these populations. Atherosclerosis begins in childhood as deposits of cholesterol and its esters, referred to as fatty streaks, in the intima of large muscular arteries. Evidence regarding the associations of adult coronary artery disease risk factors with atherosclerosis in young persons have been described (1). These observations raise implications for the long-range prevention of coronary artery disease, starting in the pediatric practice. Before the use of high-resolution ultrasound techniques to assess vascular function, anatomical and functional evidence for atherogenesis could only be recognized by invasive investigations or on postmortem examination (2). Today, these noninvasive methods are commonly used to assess endothelial function and to detect early anatomical evidence of atherogenesis in adult and pediatric populations. The most widely used test to evaluate endothelial function measures the vasodilator response to increased blood flow of the brachial artery (flow mediated vasodilatation) (3). Adult studies have demonstrated that the endothelial function of the peripheral circulation is closely related to that of the coronary circulation. The remodeling of the large arteries can be evaluated by the measure of the thickening of the intima and media of the common carotid arteries, or of the aorta (4). These approaches give an estimation of the local or regional function of the examined arterial bed. However, a more global evaluation of the physic...

Time-related arterial changes after allogeneic hematopoietic stem cell transplantation in children

“…The endothelial cells control the tone of the vascular smooth muscle, control the activity of the coagulation status, and act in the immune response through an interaction with circulating leukocytes. Disturbances in arterial mechanical properties have been shown to relate to endothelial dysfunction and risk of cardiovascular events (16), and in our HSCT study population, these disturbances were observed at a very young age. Our findings also suggest that the changes in the arterial wall may increase with time passed since HSCT.…”

Ischemia-modified albumin as a marker of vascular dysfunction and subclinical atherosclerosis in β-thalassemia major

“…The most frequently used methods for assessment of vascular dysfunction in the pediatric population are the quantification of flow-mediated, endothelium-dependent dilation of the brachial artery and measurement of the intima media thickening of the carotid artery. Increased intima media thickness was correlated with late cardiovascular events and/or mortality in adults [69]. In addition to its association with known cardiovascular risk factors and both prevalent and incident coronary heart disease, the rate of CIMT progression is directly related to the risk for future cardiovascular events [70].…”

Measurement of pulse wave velocity in children and young adults: a comparative study using three different devices

“…1 Deterioration in endothelial function and arterial stiffness are early events in the development of cardiovascular damage. Although there is ample evidence that arteriosclerosis begins in childhood, [2][3][4] hard end points, such as stroke, ischemic heart disease and death, are rare or virtually lacking in the pediatric population. Thus, there is an increasing need to establish validated noninvasive predictors to forecast early arterial disease and to be able to characterize elevated cardiovascular risk in youngsters.…”