Carotid artery intimal-medial thickness and left ventricular hypertrophy in children with elevated blood pressure
Jonathan M Sorof1, Andrei V Alexandrov, Gina Cardwell
1Department of Pediatrics, University of Texas Medical School at Houston, Houston, Texas 77030, USA. jsorof@uth.tmc.edu
Insights
Elevated blood pressure in children is linked to early arterial changes. Carotid artery ultrasound may predict cardiovascular risks in hypertensive youth.
Area of Science:
- Pediatric Cardiology
- Vascular Ultrasound
- Hypertension Research
Background:
- Pediatric hypertension is a growing concern with potential long-term cardiovascular implications.
- Early detection of subclinical cardiovascular changes is crucial for risk stratification in children.
Purpose of the Study:
- To investigate the association between carotid artery intimal-medial thickness (cIMT) and left ventricular mass index (LVMI) in children with elevated blood pressure.
- To assess if cIMT can serve as an early marker for cardiac changes in pediatric hypertension.
Main Methods:
- Thirty-two untreated children with confirmed elevated blood pressure underwent echocardiography for LVMI calculation and carotid duplex ultrasound for cIMT measurement.
- LVMI was indexed to height, and LVH was defined as LVMI >95th percentile.
- cIMT was measured in the distal common carotid artery by experienced sonographers unaware of echocardiographic results.
Main Results:
- The prevalence of left ventricular hypertrophy (LVH) and increased cIMT was 41% and 28%, respectively.
- Children with increased cIMT exhibited significantly higher LVMI compared to those with normal cIMT.
- A strong positive correlation was observed between cIMT and LVMI (r = 0.54), even after adjusting for age, gender, and BMI.
Conclusions:
- Increased cIMT is associated with higher LVMI and a greater prevalence of LVH in hypertensive children.
- Carotid duplex ultrasound may identify early arterial wall changes, potentially predicting other cardiovascular sequelae in this population.
- These findings highlight the utility of non-invasive vascular imaging in managing pediatric hypertension.
Objectives:
To determine the association between carotid artery intimal-medial thickness (cIMT) and left ventricular mass index (LVMI) in children with elevated blood pressure.
Methods:
Study subjects (n = 32; mean age: 13.9 +/- 2.7 years) were untreated new referrals to a pediatric hypertension clinic with confirmed elevated blood pressure. LVM was calculated from 2-dimensionally guided m-mode echocardiographic measurements of the left ventricle. LVMI was calculated as LVM (g)/height (m)2.7, and left ventricular hypertrophy (LVH) was defined as LVMI >95th percentile. Carotid artery duplex ultrasound was performed by protocol by experienced vascular sonographers who were unaware of the echocardiography results. The thickest IMT complex of the far wall of the distal common carotid artery was measured in longitudinal B-mode section using a high-resolution linear array of 8 MHz.
Results:
The prevalence of LVH and increased cIMT was 41% and 28%, respectively. Subjects with increased cIMT had higher LVMI (46.8 g/m2.7 vs 31.4 g/m2.7) than those with normal cIMT. The LVH prevalence was 89% (8 of 9) among subjects with increased cIMT as compared with 22% (5 of 23) in subjects with normal cIMT. cIMT was positively correlated with body mass index (r = 0.43), interventricular septal thickness (r = 0.58), posterior wall thickness (r = 0.54), and LVMI (r = 0.54). cIMT and LVMI were positively associated after accounting for age, gender, and body mass index.
Conclusions:
These findings raise the possibility that carotid duplex ultrasound, by indicating the presence of early arterial wall changes, may be useful for predicting other cardiovascular sequelae in hypertensive children.
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