Left Ventricular Diastolic Dysfunction Among Youth with Obesity and History of Elevated Blood Pressure

To assess prevalence of and factors associated with left ventricular diastolic dysfunction (LVDD) in youth with obesity and elevated blood pressure (BP).

This was a cross-sectional analysis of baseline and follow-up visits of 83 youth, 5-21 years, evaluated for overweight/obesity and elevated BP in a multidisciplinary clinic. LVDD was defined according to established adult criteria (LVDD_adult; E/A < 1, E/e' > 14, or e'/a' < 0.8) and pediatric criteria (LVDD_peds; E/A <10th percentile, E/e' >99th percentile, or e'/a' <1st percentile) based on data from 103 age-sex matched healthy controls. Baseline factors associated with LVDD_peds were examined using Wilcoxon rank sum and χ² tests. Multiple logistic regression analyses using generalized estimating equations to account for repeated measures evaluated the associations of adiposity and BP with LVDD_peds.

The prevalence of LVDD ranged from 1.2% to 2.7% when we used adult criteria and 19% to 28% when we used pediatric criteria. Those with LVDD_peds were older, predominantly male, and non-African American and had greater weight, BP, BP medication use, and non-high-density lipoprotein cholesterol than those without LVDD_peds. Diastolic BP z score was associated with LVDD_peds by E/A (OR 1.95, 95% CI 1.15-3.32, P = .014) after we adjusted for age, sex, race, BP medications, and body mass index z score.

LVDD was present in a substantial proportion of youth with overweight/obesity and elevated BP using pediatric criteria. Those with LVDD_peds had significantly greater measures of adiposity and BP compared with those without LVDD_peds, and diastolic BP z score was an independent predictor of LVDD_peds by E/A. These data emphasize the importance of prevention and treatment of cardiovascular disease risk factors in childhood.