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

Published online by Cambridge University Press:  06 January 2022

Michelle L. Udine Open the ORCID record for Michelle L. Udine [Opens in a new window] ,
Jonathan R. Kaltman ,
Qianxi Li ,
Jin Liu ,
Deyu Sun ,
Man Ching Cheung ,
Sam Sabouni ,
Ahmed Al Dulaimi  and
Craig Sable
Michelle L. Udine*
Affiliation:
Division of Cardiology, Children’s National Hospital, Washington, DC, USA
Jonathan R. Kaltman
Affiliation:
Division of Cardiology, Children’s National Hospital, Washington, DC, USA
Qianxi Li
Affiliation:
Philips Research North America, Cambridge, MA, USA
Jin Liu
Affiliation:
Philips Research North America, Cambridge, MA, USA
Deyu Sun
Affiliation:
Philips Research North America, Cambridge, MA, USA
Man Ching Cheung
Affiliation:
Philips Research North America, Cambridge, MA, USA
Sam Sabouni
Affiliation:
Division of Cardiology, Children’s National Hospital, Washington, DC, USA
Ahmed Al Dulaimi
Affiliation:
Division of Cardiology, Children’s National Hospital, Washington, DC, USA
Craig Sable
Affiliation:
Division of Cardiology, Children’s National Hospital, Washington, DC, USA
*
Author for correspondence: M. Udine, MD, 111 Michigan Avenue NW-WW 300, Suite 200, Washington, DC 20010, USA. Tel: (202) 476-2315; Fax: (202) 476-5700. E-mail: mudine2@childrensnational.org
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Abstract

Objective:

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.

Study design:

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.

Results:

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.

Conclusions:

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.

Keywords

Left ventricular hypertrophyhypertensionraceobesitypreventive cardiologyechocardiogramelectrocardiogram
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 6 , June 2022 , pp. 855 - 860
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Copyright
© The Author(s), 2022. Published by Cambridge University Press

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References

Lai, C-C, Sun, D, Cen, R, et al. Impact of long-term burden of excessive adiposity and elevated blood pressure from childhood on adulthood left ventricular remodeling patterns: the Bogalusa Heart Study. J Am Coll Cardiol 2014; 64: 1580–1587.10.1016/j.jacc.2014.05.072CrossRefGoogle ScholarPubMed
Juonala, M, Magnussen, G, Berenson, GS, et al. Childhood adiposity, adult adiposity, and cardiovascular risk factors. N Engl J Med 2011; 365: 1876–1885.CrossRefGoogle ScholarPubMed
Hanevold. Erratum: the effects of obesity, gender, and ethnic group on left ventricular hypertrophy and geometry in hypertensive children: a collaborative study of the international pediatric hypertension association. Pediatrics 2004; 113: 328–333. DOI 10.1542/peds.2005-0480.10.1542/peds.113.2.328CrossRefGoogle Scholar
Pruette, CS, Fivush, BA, Flynn, JT, Brady, TM. Effects of obesity and race on left ventricular geometry in hypertensive children. Pediatr Nephrol 2013; 28: 2015–2022. DOI 10.1007/s00467-013-2507-7.CrossRefGoogle ScholarPubMed
Mynard, JP, Park, CM, Ntsinjana, HN, et al. Racial differences in left ventricular mass and wave reflection intensity in children. Front Pediatr 2020; 8: 132. DOI 10.3389/fped.2020.00132.Google Scholar
Falkner, B, Deloach, S, Keith, SW, Gidding, SS. High risk blood pressure and obesity increase the risk for left ventricular hypertrophy in african-american adolescents. J Pediatr 2013; 162: 94–100. DOI 10.1016/j.jpeds.2012.06.009.10.1016/j.jpeds.2012.06.009CrossRefGoogle ScholarPubMed
Stabouli, S, Kotsis, V, Rizos, Z, et al. Left ventricular mass in normotensive, prehypertensive and hypertensive children and adolescents. Pediatr Nephrol 2009; 24: 1545–1551. DOI 10.1007/s00467-009-1165-2.CrossRefGoogle ScholarPubMed
Ramaswamy, P, Chikkabyrappa, S, Donda, K, Osmolovsky, M, Rojas, M, Rafii, D. Relationship of ambulatory blood pressure and body mass index to left ventricular mass index in pediatric patients with casual hypertension. J Am Soc Hypertens 2016; 10: 108–114. DOI 10.1016/j.jash.2015.11.009.10.1016/j.jash.2015.11.009CrossRefGoogle ScholarPubMed
Urbina, EM, Mendizábal, B, Becker, RC, et al. Association of blood pressure level with left ventricular mass in adolescents. Hypertension 2019; 74: 590–596. DOI 10.1161/hypertensionaha.119.13027.CrossRefGoogle ScholarPubMed
Tague, L, Wiggs, J, Li, Q, et al. Comparison of left ventricular hypertrophy by electrocardiography and echocardiography in children using analytics tool. Pediatr Cardiol 2018; 39: 1378–1388. DOI 10.1007/s00246-018-1907-7.CrossRefGoogle ScholarPubMed
Khoury, PR, Mitsnefes, M, Daniels, SR, Kimball, TR. Age-specific reference intervals for indexed left ventricular mass in children. J Am Soc Echocardiogr 2009; 22: 709–714. DOI 10.1016/j.echo.2009.03.003.10.1016/j.echo.2009.03.003CrossRefGoogle ScholarPubMed
Flynn, JT, Kaelber, DC, Baker-Smith, CM. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics 2017; 140: e20171904.10.1542/peds.2017-1904CrossRefGoogle ScholarPubMed
Foster, BJ, Gao, T, Mackie, AS, et al. Limitations of expressing left ventricular mass relative to height and to body surface area in children. J Am Soc Echocardiogr 2013; 26: 410–418. DOI 10.1016/j.echo.2012.11.018.CrossRefGoogle ScholarPubMed