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The effect of hypertension and obesity on left ventricular geometry and cardiac functions in children and adolescents

Alp, Hayrullaha; Karaarslan, Sevimb; Eklioğlu, Beray S.c; Atabek, Mehmet E.c; Baysal, Tamerb

doi: 10.1097/HJH.0000000000000176
ORIGINAL PAPERS: Childhood hypertension

Objectives: Obesity and hypertension are associated with structural and functional cardiac change in children and adults. The aim of the study is to evaluate the effect of hypertension and obesity on left ventricular geometric patterns and cardiac functions assessed by conventional and Doppler echocardiography.

Methods: Four hundred and thirty obese children, aged 6–17 years and 150 age and sex-matched healthy controls, were included in the study. Left ventricular geometry was classified as concentric hypertrophy, eccentric hypertrophy, concentric remodeling and normal geometry.

Results: Concentric hypertrophy group had the worst subclinical systolic and diastolic cardiac functions among all left ventricular geometric patterns. BMI and total adipose tissue mass are the predictors of abnormal ventricular geometry. Apart from the increase in carotid intima–media and epicardial adipose tissue thicknesses in different left ventricular geometry patterns, they are not predictable for abnormal geometry.

Conclusion: The variety of alterations in cardiac function and morphology that has been observed in obese adults, appears to start earlier in life. Obesity and hypertension were clearly associated with the left ventricular geometry. Also, subclinical systolic and load-depended diastolic dysfunctions can be detected in obese hypertensive children with concentric hypertrophy.

aDepartment of Pediatric Cardiology, Malatya State Hospital, Malatya

bDepartment of Pediatric Cardiology, Necmettin Erbakan University, Meram School of Medicine Hospital

cDepartment of Pediatric Endocrinology, Necmettin Erbakan University, Meram School of Medicine Hospital, Konya, Turkey

Correspondence to Hayrullah Alp, Department of Pediatric Cardiology, Malatya State Hospital, Malatya, 44110, Turkey. Tel: 00904222121010; fax: 00904222121020; e-mail: drhayrullahalp@hotmail.com

Abbreviations: LV, left ventricle; RV, right ventricle; LVM, left ventricular mass; LVMI, left ventricular mass index; BSA, body surface area; LDL, low-density lipoprotein; HDL, high-density lipoprotein; HOMA-IR, homeostasis model of assessment-insulin resistance; IVSs, interventricular septum systolic thickness; IVSd, interventricular septum diastolic thickness; LVEsD, left ventricular end-systolic dimension; LVEdD, left ventricular end-diastolic dimention; LVPWs, left ventricular posterior wall systolic thickness; LVPWd, left ventricular posterior wall diastolic thickness; RWT, relative wall thickness; E, early mitral/tricuspid diastolic velocity; A, late mitral/tricuspid diastolic velocity; MPI, myocardial performance index; e’, peak early diastolic myocardial velocity; a’, peak atrial systolic velocity; s’, peak systolic myocardial velocity; EAT, epicardial adipose tissue; IMT, intima–media thickness; DTI, Doppler tissue imaging

Received 5 October, 2013

Revised 25 December, 2013

Accepted 14 February, 2014

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins