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Growth parameters and endocrine function in relation to echocardiographic parameters in children with ventricular
A T Soliman1, A Madkour, M A Galil
1Department of Child Health, University of Alexandria, Egypt. atsoliman@yahoo.com
Insights
Children with ventricular septal defects (VSD) show impaired linear growth due to larger shunt size and abnormal pulmonary hemodynamics, leading to reduced insulin-like growth factor-I (IGF-I) synthesis.
Area of Science:
- Pediatric Cardiology
- Endocrinology
- Growth and Development
Background:
- Ventricular septal defects (VSD) can impact children's overall health and development.
- Understanding factors affecting linear growth in children with VSD is crucial for timely intervention.
Purpose of the Study:
- To investigate the influence of ventricular function, VSD size, and endocrine status on linear growth in children with VSD.
- To correlate cardiac parameters with growth indicators and endocrine markers.
Main Methods:
- Studied 88 children with VSD, assessing height standard deviation scores (HtSDS) and growth velocity (GV) over one year.
- Performed echocardiography to evaluate cardiac parameters, including shunt size (Qp/Qs).
- Assessed endocrine function in a subset of patients, measuring growth hormone (GH) and insulin-like growth factor-I (IGF-I).
Main Results:
- Children with VSD exhibited significantly decreased HtSDS, BMI, and mid-arm circumference compared to controls.
- Reduced IGF-I levels and elevated GH levels were observed in children with VSD.
- HtSDS and growth velocity showed significant negative correlations with shunt size and pulmonary hemodynamic parameters.
Conclusions:
- The size of the left-to-right shunt and abnormal pulmonary circulation hemodynamics are key factors contributing to impaired growth in VSD patients.
- A hypermetabolic state in VSD patients may compromise nutrition, reduce IGF-I synthesis, and slow linear growth and weight gain.
Abstract:
To determine the effect of ventricular function, size of ventricular septal defect (VSD), and endocrine function on linear growth in children with VSD, we studied 88 children with VSD over a period of 1 year. Growth was assessed by determining the height standard deviation scores (HtSDS) and growth velocity (GV) every 4 months. Two hundred age-matched normal children served as controls for the growth data. Endocrine evaluation was performed in 30 randomly selected children with VSD, and 20 age-matched children with constitutional delay of growth (CSS). Growth hormone (GH) response to clonidine provocation was evaluated and circulating free thyroxine (FT4) and insulin-like growth factor-I (IGF-I) concentrations measured. Echocardiographic evaluation of the different cardiac parameters including shunt size and shunt fraction (Qp/Qs) was performed using a colour-coded echodoppler. The HtSDS, body mass index (BMI), and mid-arm circumference (MAC) of children with VSD were significantly decreased compared to those for the normal control group. The dietary intake evaluated by the recall method, appeared to be adequate in the majority of these children (83/88). IGF-I concentrations were reduced in children with VSD (87.5 +/- 29 ng/ml) versus normal age-matched children (169 +/- 42 ng/ml). Basal and clonidine-stimulated GH concentrations were significantly higher in children with VSD (4.6 +/- 2.1 microg/l and 28.8 +/- 7.9 microg/l respectively) versus controls (17.8 +/- 4.2 microg/l). In these patients (n = 88) the HtSDS was correlated negatively with the size of the shunt (r = -0.793, p < 0.001), shunt fraction (Qp/Qs) (r = -0.76, p < 0.001), pulmonary mean gradient (r = -0.4, p = 0.006), and pulmonary maximum velocity (r = -0.32, p = 0.02). Growth velocity (GV) was correlated negatively with pulmonary maximum gradient (r = -0.3, p = 0.02), pulmonary maximum velocity (r = -0.37, p = 0.007), and pulmonary stroke volume (Qp) (r = -0.345, p = 0.01). The BMI and IGF-I concentrations were correlated significantly with the size of the shunt (r = -0.453, p < 0.01), Qp/Qs (r = -0.432, p < 0.01), HtSDS (r = 0.565, p < 0.01), and BMI (r = 0.435, p < 0.01). It appears that in patients with VSD, the size of the left-to-right shunt and the abnormal hemodynamics in the pulmonary circulation are important factors in the etiology of impaired growth. It is suggested that the hypermetabolic status of these patients compromise nutrition and this decreases IGF-I synthesis with subsequent slowing of linear growth and weight gain.
