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Left ventricular dysfunction and subclinical atherosclerosis in children with classic congenital adrenal hyperplasia:
Kotb Abbass Metwalley1,2, Hekma Saad Farghaly3, Tahra Sherief4
1Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt. kotb72@yahoo.com.
Insights
Children with congenital adrenal hyperplasia (CAH) show early signs of vascular damage and heart dysfunction, particularly those with higher androgen levels. Early cardiovascular monitoring is crucial for these children.
Area of Science:
- Pediatric Endocrinology
- Cardiovascular Medicine
- Pediatric Cardiology
Background:
- Congenital adrenal hyperplasia (CAH) is a group of genetic disorders affecting the adrenal glands.
- Limited research exists on cardiovascular changes in pediatric CAH patients compared to adults.
- Vascular and myocardial function assessments are crucial for understanding long-term health in children with CAH.
Purpose of the Study:
- To evaluate carotid artery structural changes and left ventricular (LV) myocardial function in children with classic CAH.
- To compare cardiovascular parameters between children with CAH and healthy controls.
- To investigate the correlation between hormonal levels and cardiovascular abnormalities.
Main Methods:
- Study included 32 children with classic CAH and 32 age-, gender-, and socioeconomically matched healthy controls.
- Assessed high-sensitivity C-reactive protein (hs-CRP) and circulating endothelial cells (CECs) for endothelial injury markers.
- Utilized echocardiography for LV mass (LVM) and function, and duplex ultrasonography for carotid artery intima-media thickness (CA-IMT).
Main Results:
- CAH patients exhibited elevated hs-CRP and CECs, increased CA-IMT, higher LVMI, and impaired LV diastolic function (lower E/A ratio, prolonged DcT and IVRTs) compared to controls.
- Cardiovascular abnormalities were more pronounced in children with uncontrolled CAH.
- Elevated testosterone levels correlated positively with CA-IMT, LVMI, and DcT.
Conclusions:
- Children with CAH, especially with elevated androgens, face a heightened risk of vascular endothelial injury, subclinical atherosclerosis, and LV dysfunction.
- These findings underscore the necessity for early and consistent cardiovascular monitoring in pediatric CAH patients.
- Prompt identification and management of cardiovascular risks are essential for improving long-term outcomes in children with CAH.
Unlabelled:
Few studies assessed carotid artery intima-media thickness (CA-IMT) and left ventricular (LV) function in children with congenital adrenal hyperplasia (CAH) as compared to adults. This study aimed to assess carotid artery structural changes and myocardial function with CAH. The study included 32 children with classic CAH and 32 healthy children matched for age, gender, pubertal status, and socioeconomic status. Blood levels of high-sensitivity C-reactive protein (hs-CRP) and circulating endothelial cells (CECs) were measured. LV mass (LVM) and function were assessed using conventional echocardiography. Duplex ultrasonography was used to measure CA-IMT. Compared to controls, patients had higher hs-CRP and CEC concentrations (p < 0.001) and increased CA-IMT (p < 0.001), indicating vascular endothelial injury and subclinical atherosclerosis; higher LVM index (LVMI) (p < 0.001), indicating LV hypertrophy; and lower ratio of E/A wave and prolonged mitral deceleration time (DcT) and isovolumic relaxation times (IVRTs) (p < 0.001), indicating LV dysfunction. Abnormalities were marked in uncontrolled children on medical treatment. Testosterone levels were positively correlated with CA-IMT, LVMI, and DcT values.
Conclusion:
This study indicates that children with CAH and enhanced androgen levels are at increased risk of vascular endothelial injury, subclinical atherosclerosis, and LV dysfunction. These findings highlight early monitoring of children with CAH for cardiovascular abnormalities.