Abstract 122: Global Longitudinal Peak Strain Detects Early Cardiac Damage in Hypertensive Children
Background: Childhood hypertension is increasingly common and likely contributes to the premature development of cardiovascular and renal disease. Early detection of hypertensive cardiac damage may allow for prompt therapy and reduce the risk of late morbidity and mortality. While left ventricular mass index (LVMI) has been used as a surrogate of hypertensive cardiac damage in children, its prognostic and diagnostic value is not completely understood in this population.
Objective: To test the hypothesis that strain assessment using automated function imaging (AFI) detects cardiac changes in hypertensive children earlier than standard 2D echocardiographic techniques.
METHODS: A cross-sectional study of hypertensive children < 19 years old between October 2010 and May 2012 was performed. Any patient who was newly diagnosed with hypertension and underwent echocardiographic examination including standard 2D, Doppler, and automated function imaging (AFI) modalities was included. Global peak longitudinal systolic strain (GLPSS) was measured using a 17 segment model of the left ventricle. All echocardiographic measures were compared to normative reference values for age.
Results: Twenty four patients (mean age 14.6 ± 2.7 years, 67% male) were identified. Mean systolic and diastolic blood pressure index was 1.1 ± 0.1 and 0.9 ± 0.1, respectively. Mean LVMI did not significantly differ from 95th-percentile normative values (41.6 ± 11.2 g/m2.7 vs. 39.3 ± 1.5 g/m2.7, p = 0.328). Mean GLPSS was significantly lower than 5th-percentile normative values (-17.6 ± 2.5 vs. -19.5 ± 0.42, p = 0.001) and were decreased across all myocardial segments. Left atrial volume was significantly higher than reported normal values in children (27.6 ± 7.3 ml/m2 vs. 22.0 ± 6.0 ml/m2, p = 0.002). No patient exhibited abnormal shortening or ejection fraction, mitral E-wave to A-wave ratio, or lateral mitral E-wave to e’-wave ratio.
Conclusions: A population of unselected, newly diagnosed hypertensive adolescents had atypically low GLPSS and increased left atrial volume. The use of GLPSS measured by AFI may be a more sensitive marker of early myocardial remodeling in hypertensive children and routine measurement of GLPSS should be considered.
- © 2012 by American Heart Association, Inc.