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Epicardial Fat Thickness in Children with Classic Congenital Adrenal Hyperplasia
Kotb Abbass Metwalley1, Hekma Saad Farghaly1, Abdelrahman Abdelhamid2
1Assiut University Faculty of Medicine, Department of Pediatrics, Assiut, Egypt
Insights
Epicardial fat thickness (EFT) is elevated in children with congenital adrenal hyperplasia (CAH), particularly those with poor disease control. Increased EFT correlates with subclinical atherosclerosis and left ventricular dysfunction, aiding risk identification.
Area of Science:
- Pediatric Endocrinology
- Cardiology
- Metabolic Syndrome
Background:
- Epicardial fat thickness (EFT) is an emerging cardio-metabolic risk factor associated with atherosclerosis.
- EFT has not been previously investigated in children with congenital adrenal hyperplasia (CAH).
Purpose of the Study:
- To evaluate epicardial fat thickness (EFT) in children diagnosed with classical CAH.
- To assess the relationship between EFT and carotid artery intima-media thickness (CA-IMT) and left ventricular (LV) functions in these children.
Main Methods:
- A cohort of 36 children with classical CAH on steroid therapy was compared to 36 healthy controls.
- Evaluations included anthropometry, fasting lipids, glucose, insulin, HOMA-IR, echocardiography for LV functions and EFT, and duplex ultrasonography for CA-IMT.
Main Results:
- Children with CAH exhibited significantly greater EFT, CA-IMT, LV mass index (LVMI), and prolonged mitral deceleration time (DcT) compared to controls.
- CAH patients also showed poorer HOMA-IR, with abnormalities more pronounced in those with uncontrolled disease.
- Multivariate analysis revealed EFT positively correlated with waist circumference, 17-hydroxyprogesterone, testosterone, LVMI, mitral DcT, and CA-IMT in CAH subjects.
Conclusions:
- Elevated EFT in children with classical CAH, especially with poor control, is linked to increased subclinical atherosclerosis and LV dysfunction.
- Measuring EFT in pediatric CAH patients may serve as a valuable tool for identifying individuals at higher risk for cardiovascular complications.
Objective:
Epicardial fat thickness (EFT) is an emerging cardio-metabolic risk factor and has been shown to be related to atherosclerosis. EFT has not been studied in the context of CAH. This study aimed to evaluate EFT in children with CAH and its relation to carotid artery intima-media thickness (CA-IMT) and left ventricular (LV) functions.
Methods:
Thirty-six children with classical CAH were compared with 36 healthy controls. All patients had confirmed CAH and were receiving steroid substitution therapy. Patients and controls underwent anthropometric evaluation, measurement of fasting lipids, glucose, insulin, homeostasis model assessment for insulin resistance (HOMA-IR). LV functions and EFT were assessed using conventional echocardiography. Duplex ultrasonography was used to measure CA-IMT.
Results:
Compared to controls, patients had greater EFT (p=0.001), CA-IMT (p=0.01), LV mass index (LVMI) (p=0.001) and prolonged mitral deceleration time (DcT) (p=0.01). CAH patients also had significantly worse HOMA-IR (p=0.001) than controls. Abnormalities were worse in uncontrolled CAH on treatment. Multivariate analysis in CAH subjects showed EFT correlated positively with waist circumference odds ratio (OR) [OR=1.9; 95% confidence interval (CI): 1.07-1.14; p=0.01], 17-hydroxyprogesterone [OR=1.6; 95% CI: 1.33-2.89; p=0.05], testosterone concentration (OR=1.7; 95% CI: 1.55-2.13; p=0.01), LVMI (OR=1.14; 95% Cl: 1.08-1.13; p=0.01), mitral DcT (OR=2.25; 95% CI: 1.15-2.05; p=0.01) and CA-IMT (OR=1.6; 95% CI: 1.15-2.05; p=0.01).
Conclusion:
EFT is elevated in children with classical CAH, particularly in those with poor control, and is correlated with CA-IMT, LV mass and mitral DcT. Measurement of EFT in CAH children may help to identify those at high risk of developing LV dysfunction and subclinical atherosclerosis.
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