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Cardiac size and function during adrenocorticotropic hormone-induced systolic systemic hypertension in infants
T J Starc1, F Z Bierman, S G Pavlakis
1Department of Pediatrics, Columbia University, College of Physicians and Surgeons, New York, New York 10032.
Insights
Adrenocorticotropic hormone (ACTH) treatment in infants led to increased systolic blood pressure and significant cardiac changes, including myocardial hypertrophy and enhanced contractility, even before hypertension onset.
Area of Science:
- Pediatric Endocrinology
- Cardiology
- Pharmacology
Background:
- Adrenocorticotropic hormone (ACTH) is crucial for adrenal steroidogenesis.
- Infants may require ACTH treatment for various medical conditions.
- Potential cardiovascular side effects of ACTH in infants are not fully understood.
Purpose of the Study:
- To investigate the effects of ACTH on blood pressure and cardiac function in infants.
- To determine the temporal relationship between ACTH exposure, hypertension, and cardiac remodeling.
- To document myocardial changes associated with ACTH treatment in pediatric patients.
Main Methods:
- 14 infants received ACTH treatment for a mean of 25 days.
- Systolic blood pressure and echocardiographic parameters (heart size, function) were measured.
- Serial measurements were analyzed in 8 infants to assess temporal changes.
- Hypertension was defined as systolic blood pressure above the 95th percentile for age.
Main Results:
- ACTH treatment significantly increased systolic blood pressure in infants.
- 10 out of 14 infants developed systolic hypertension during ACTH therapy.
- Left ventricular shortening fraction increased significantly, indicating enhanced contractility.
- Myocardial hypertrophy and altered LV dimensions were observed, preceding or concurrent with hypertension.
Conclusions:
- ACTH administration in infants can induce significant cardiovascular changes, including hypertension and myocardial alterations.
- Cardiac changes, such as increased contractility and hypertrophy, may precede the development of overt hypertension.
- These findings highlight the importance of monitoring cardiovascular status in infants receiving ACTH therapy.
Abstract:
The effects of adrenocorticotropic hormone (ACTH) on systolic blood pressure, and echocardiographic indexes of heart size and function were investigated in 14 infants. After 25 days (range 13 to 46) of treatment with ACTH, systolic blood pressure increased from 93 +/- 9 to 118 +/- 20 mm Hg (p < 0.001; mean +/- 1 SD). Systolic hypertension (systolic blood pressure greater than the 95th percentile for age) developed in 10 of 14 infants and was associated with an increase in left ventricular (LV) shortening fraction from 41 +/- 5% to 52 +/- 8% (p < 0.001). Myocardial hypertrophy and an increase in echocardiographic indexes of myocardial contractility were observed also. To assess the temporal relation between the onset of systolic hypertension and these cardiac changes, data from 8 infants with serial echocardiograms and blood pressure determinations were examined. After a mean 14 days (range 8 to 18) of ACTH, LV shortening fraction increased from 39 +/- 6% to 53 +/- 8% (p < 0.01), whereas systolic blood pressure remained normal in 7 of 8 infants. In addition, a decrease in LV end-systolic dimension was observed during this early phase. This report documents myocardial changes in individual patients, which occur before and during the development of systolic hypertension.