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Updated: Dec 24, 2025
Evaluation of Left Ventricular Structure and Function using 3D Echocardiography
Published on: October 28, 2020
Racial Differences in Left Ventricular Mass and Wave Reflection Intensity in Children
Kevin S Heffernan1, Wesley K Lefferts2, Nader H Atallah-Yunes3
1Department of Exercise Science, Syracuse University, Syracuse, NY, United States.
Insights
Racial disparities in heart health begin in childhood. African American children show higher left ventricular mass and greater central hemodynamic load compared to non-Hispanic white children, indicating early risks for cardiac damage.
Area of Science:
- Cardiovascular Science
- Pediatric Cardiology
- Health Disparities Research
Background:
- Heart failure burden is disproportionately high in African Americans, starting at an early age.
- Racial differences in childhood left ventricular mass (LVM) may predict adult cardiac target organ damage (cTOD).
- Central hemodynamic load, a precursor to cTOD, is elevated in African Americans.
Purpose of the Study:
- To investigate racial disparities in central hemodynamic load and LVM between African American and non-Hispanic white (NHW) children.
- To explore early life origins of racial differences in cardiovascular health.
Main Methods:
- Study included 269 children (age 10 ± 1 years; 154 African American, 149 female).
- Carotid pulse wave velocity (PWV), forward wave intensity (W1), and reflected wave intensity (NA) were assessed using wave intensity analysis (WIA).
- LVM was measured by echocardiography and indexed to height; left ventricular hypertrophy (LVH) defined by a cutoff of 45 g/m(2.16).
Main Results:
- African American children had significantly higher LVM (39.2 ± 8.0 vs. 37.2 ± 6.7 g/m(2.16)) and a greater proportion of LVH (25% vs. 12%) compared to NHW children, after adjustments.
- No significant racial differences were found in carotid PWV.
- African American children exhibited higher wave reflection magnitude (NA/W1) (8.5 ± 5.3 vs. 6.7 ± 2.9), and adjusting for this attenuated LVM racial differences.
Conclusions:
- Racial disparities in central hemodynamic load and cTOD are evident in childhood.
- African American children demonstrate increased wave intensity from reflected waves and higher LVM index compared to NHW children.
- Wave intensity analysis provides valuable insights into the early developmental origins of cardiovascular disparities.
Abstract:
The burden of heart failure is disproportionately higher in African Americans, with a higher prevalence seen at an early age. Examination of racial differences in left ventricular mass (LVM) in childhood may offer insight into risk for cardiac target organ damage (cTOD) in adulthood. Central hemodynamic load, a harbinger of cTOD in adults, is higher in African Americans. The purpose of this study was to examine racial differences in central hemodynamic load and LVM in African American and non-Hispanic white (NHW) children. Two hundred sixty-nine children participated in this study (age, 10 ± 1 years; n = 149 female, n = 154 African American). Carotid pulse wave velocity (PWV), forward wave intensity (W1) and reflected wave intensity (negative area, NA) was assessed from simultaneously acquired distension and flow velocity waveforms using wave intensity analysis (WIA). Wave reflection magnitude was calculated as NA/W1. LVM was assessed using standard 2D echocardiography and indexed to height as LVM/[height (2.16) + 0.09]. A cutoff of 45 g/m (2.16) was used to define left ventricular hypertrophy (LVH). LVM was higher in African American vs. NHW children (39.2 ± 8.0 vs. 37.2 ± 6.7 g/m (2.16), adjusted for age, sex, carotid systolic pressure and socioeconomic status; p < 0.05). The proportion of LVH was higher in African American vs. NHW children (25 vs. 12 %, p < 0.05). African American and NHW children did not differ in carotid PWV (3.5 ± 4.9 vs. 3.3 ± 1.3 m/s; p > 0.05). NA/W1 was higher in African American vs. NHW children (8.5 ± 5.3 vs. 6.7 ± 2.9; p < 0.05). Adjusting for NA/W1 attenuated racial differences in LVM (38.8 ± 8.0 vs. 37.6 ± 7.0 g/m (2.16); p = 0.19). In conclusion, racial differences in central hemodynamic load and cTOD are present in childhood. African American children have greater wave intensity from reflected waves and higher LVMI compared to NHW children. WIA offers novel insight into early life origins of racial differences in central hemodynamic load and cTOD.
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