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Left ventricular mass by echocardiographic measures in children and adolescents

Published online by Cambridge University Press:  20 November 2012

Sudhir K. Mehta*
Affiliation:
Department of Pediatric Cardiology, Cleveland Clinic Children's Hospital, Cleveland, Ohio, United States of America Heart and Vascular Center, Fairview Hospital, Cleveland Clinic Health System, Cleveland, Ohio, United States of America
*
Correspondence to: Dr S. K. Mehta, MD, MBA, Chairman of Pediatrics, Fairview Hospital, 18101 Lorain Avenue, Cleveland, Ohio 44111-5656, United States of America. Tel: 216 476 7236; Fax: 216 476 7021; E-mail: [email protected]

Abstract

Background

Recent evidence in adults suggests that left ventricular mass measured as left ventricular mass/height1.7 predicts cardiovascular morbidity and mortality better than the two widely used indices, left ventricular mass/body surface area and left ventricular mass/height2.7. Standards of left ventricular mass/height1.7 have not been reported in children, for whom, owing to lack of significant cardiovascular morbidity and mortality, body mass index has traditionally been used as a potential cardiovascular risk factor.

Methods

In this retrospective study, 692 clinically normal children aged 1 day to 18 years underwent detailed echocardiographic assessment to assess whether any of the left ventricular mass indices – left ventricular mass/height1.7, left ventricular mass/body surface area, and left ventricular mass/height2.7 – are associated with obesity as measured by body mass index. Correlations, t-tests, and linear regressions were used for statistical testing.

Results

Left ventricular mass/height1.7 was better correlated (R2 = 0.36) with body mass index than left ventricular mass/body surface area (R2 = 0.179) and left ventricular mass/height2.7 (R2 = 0.006), although all three dependent variables show a significant correlation (p < 0.035). In addition, a higher percentage of obese patients were noted to have elevated left ventricular mass as measured by left ventricular mass/height1.7 than by the other two methods.

Conclusions

Left ventricular mass/height1.7 is a reliable indicator of obesity-associated left ventricular hypertrophy. Left ventricular mass/height1.7 can be used conveniently during transitions from youth to adults for long-term follow-up. These findings support the importance of including left ventricular mass/height1.7 in future studies of cardiovascular risks and preventive strategies in children and adolescents.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2012 

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References

1. Bluemke, DA, Kronmal, RA, Lima, JA, et al. The relationship of left ventricular mass and geometry to incident cardiovascular events: the MESA (Multi-Ethnic Study of Atherosclerosis) study. J Am Coll Cardiol 2008; 52: 21482155.Google Scholar
2. Barbieri, A, Bursi, F, Mantovani, F, et al. Prognostic impact of left ventricular mass severity according to the classification proposed by the American Society of Echocardiography/European Association of Echocardiography. J Am Soc Echocardiogr 2011; 24: 13831391.Google Scholar
3. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents, Pediatrics, 2004; 114 (2 Suppl): 555–576.Google Scholar
4. de Simone, G, Kizer, JR, Chinali, M, et al. Strong Heart Study Investigators. Normalization for body size and population-attributable risk of left ventricular hypertrophy: the strong heart study. Am J Hypertens 2005; 18: 191196.Google Scholar
5. de Simone, G, Daniels, SR, Devereux, RB, et al. Left ventricular mass and body size in normotensive children and adults: assessment of allometric relations and impact of overweight. J Am Coll Cardiol 1992; 20: 12511260.CrossRefGoogle ScholarPubMed
6. Foster, BJ, Mackie, AS, Mitsnefes, M, Ali, H, Mamber, S, Colan, SD. A novel method of expressing left ventricular mass relative to body size in children. Circulation 2008; 117: 27692775.Google Scholar
7. Chirinos, JA, Segers, P, De Buyzere, ML, et al. Left ventricular mass: allometric scaling, normative values, effect of obesity, and prognostic performance. Hypertension 2010; 56: 9198.Google Scholar
8. Kuczmarski, RJ, Ogden, CL, Guo, SS, et al. 2000 CDC Growth Charts for the United States: methods and development. Vital Health Stat 2002; 11: 1190.Google Scholar
9. Himes, JH, Dietz, WH. Guidelines for overweight in adolescent preventive services: recommendations from an expert committee. Am J Clin Nutr 1994; 59: 307316.Google Scholar
10. Haycock, GB, Schwartz, GJ, Wisotsky, DH. Geometric method for measuring body surface area: a height–weight formula validated in infants, children, and adults. J Pediatr 1978; 93: 6266.Google Scholar
11. Sluysmans, T, Colan, SD. Theoretical and empirical derivation of cardiovascular allometric relationships in children. J Appl Physiol 2005; 99: 445457.CrossRefGoogle ScholarPubMed
12. Lang, RM, Bierig, M, Devereux, RB, et al. Chamber Quantification Writing Group; American Society of Echocardiography's Guidelines and Standards Committee; European Association of Echocardiography. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. Chamber Quantification Writing Group; American Society of Echocardiography's Guidelines and Standards Committee; European Association of Echocardiography. J Am Soc Echocardiogr 2005; 18: 14401463.Google Scholar
13. Daniels, SR, Kimball, TR, Morrison, JA, Khoury, P, Witt, S, Meyer, RA. Effect of lean body mass, fat mass, blood pressure, and sexual maturation on left ventricular mass in children and adolescents. Circulation 1995; 92: 32493254.Google Scholar
14. Khoury, PR, Mitsnefes, M, Daniels, SR, Kimball, TR. Age-specific reference intervals for indexed left ventricular mass in children. J Am Soc Echocardiogr 2009; 22: 709714.Google Scholar
15. Tanner, JM, Davies, PS. Clinical longitudinal standards for height and height velocity for North American children. J Pediatr 1985; 107: 317329.Google Scholar
16. Gidding, SS, Carnethon, MR, Daniels, S, et al. Low cardiovascular risk is associated with favorable left ventricular mass, left ventricular relative wall thickness, and left atrial size: the CARDIA Study. J Am Soc Echocardiogr 2010; 23: 816822.Google Scholar
17. Ippisch, HM, Inge, TH, Daniels, SR, et al. Reversibility of cardiac abnormalities in morbidly obese adolescents. J Am Coll Cardiol 2008; 51: 13421348.CrossRefGoogle ScholarPubMed