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Non-invasive assessment of endothelial function in children with obesity and lipid disorders

Published online by Cambridge University Press:  05 May 2015

Lisa C. Hudgins ,
Vidhya Annavajjhala ,
Arzu Kovanlikaya ,
Maura D. Frank ,
Aliza Solomon ,
Thomas S. Parker  and
Rubin S. Cooper
Lisa C. Hudgins*
Affiliation:
The Rogosin Institute, New York, United States of America
Vidhya Annavajjhala
Affiliation:
Departments of Pediatric Cardiology, Ambulatory Pediatrics, Gastroenterology and Radiology, Weill Cornell Medical College, New York, United States of America
Arzu Kovanlikaya
Affiliation:
Departments of Pediatric Cardiology, Ambulatory Pediatrics, Gastroenterology and Radiology, Weill Cornell Medical College, New York, United States of America
Maura D. Frank
Affiliation:
Departments of Pediatric Cardiology, Ambulatory Pediatrics, Gastroenterology and Radiology, Weill Cornell Medical College, New York, United States of America
Aliza Solomon
Affiliation:
Departments of Pediatric Cardiology, Ambulatory Pediatrics, Gastroenterology and Radiology, Weill Cornell Medical College, New York, United States of America
Thomas S. Parker
Affiliation:
The Rogosin Institute, New York, United States of America
Rubin S. Cooper
Affiliation:
Departments of Pediatric Cardiology, Ambulatory Pediatrics, Gastroenterology and Radiology, Weill Cornell Medical College, New York, United States of America Department of Pediatric Cardiology, Hofstra North Shore-LIJ School of Medicine, Hempstead, New York, United States of America
*
Correspondence to: L. C. Hudgins, MD, The Rogosin Institute, 310 E. 67th St., NY, NY 10021, United States of America. Tel: 646 317 0805; Fax: 646 317 0820; E-mail: [email protected]
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Abstract

Background

Digital tonometry is designed to non-invasively screen for endothelial dysfunction by the detection of impaired flow-induced reactive hyperaemia in the fingertip. We determined whether digital reactive hyperaemia correlated with risk factors for atherosclerosis in two groups of children at increased risk for endothelial dysfunction.

Methods

A total of 15 obese children and 23 non-obese, dyslipidaemic children, 8–21 years of age, were enrolled, and their medical histories, anthropometric measurements, carotid wall thickness by means of ultrasonography, and fasting blood samples for cardiovascular risk factors were obtained. The standard endoPAT index of digital reactive hyperaemia was modified to reflect the true peak response or the integrated response of the entire post-occlusion period. In each group, age, sex, pubertal status, carotid wall thickness, and multiple cardiovascular risk factors were tested as predictors of endothelial dysfunction.

Results

In the non-obese, dyslipidaemic group, but not in the obese group, both indices strongly correlated with height (r=0.55, p=0.007, by peak response) followed by weight, waist circumference, and age. In both groups, neither index of reactive hyperaemia significantly correlated with any other cardiovascular risk factor.

Conclusions

Contrary to the known age-related increase in atherosclerosis, digital reactive hyperaemia increased with age and its correlates in non-obese, dyslipidaemic children and was not related to other cardiovascular risk factors in either group. The reason for the lack of this relationship with age in obese children is unknown. The age-dependent physiology of digital microvascular reactivity and the endothelium-independent factors controlling the peak hyperaemic response need further study in children with a wide age range.

Keywords

Endothelial dysfunctionperipheral arterial tonometryhyperlipidaemia
Type
Original Articles
Information
Cardiology in the Young , Volume 26 , Issue 3 , March 2016 , pp. 532 - 538
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Copyright
© Cambridge University Press 2015 

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References

1. Daniels, SR, Greer, FR. Lipid screening and cardiovascular health in childhood. Pediatrics 2008; 122: 198–208.Google Scholar
2. Bonetti, PO, Pumper, GM, Higano, ST, Holmes, DR Jr, Kuvin, JT, Lerman, A. Noninvasive identification of patients with early coronary atherosclerosis by assessment of digital reactive hyperemia. J Am Coll Cardiol 2004; 44: 2137–2141.Google Scholar
3. Tierney, ES, Newburger, JW, Gauvreau, K, et al. Endothelial pulse amplitude testing: feasibility and reproducibility in adolescents. J Pediatr 2009; 154: 901–905.Google Scholar
4. McCrea, CE, Skulas-Ray, AC, Chow, M, West, SG. Test-retest reliability of pulse amplitude tonometry measures of vascular endothelial function: implications for clinical trial design. Vasc Med 2012; 17: 29–36.Google Scholar
5. Nohria, A, Gerhard-Herman, M, Creager, MA, Hurley, S, Mitra, D, Ganz, P. Role of nitric oxide in the regulation of digital pulse volume amplitude in humans. J Appl Physiol 2006; 101: 545–548.Google Scholar
6. Hamburg, NM, Keyes, MJ, Larson, MG et al. Cross-sectional relations of digital vascular function to cardiovascular risk factors in the Framingham Heart Study. Circulation 2008; 117: 2467–2474.Google Scholar
7. Kuvin, JT, Mammen, A, Mooney, P, Alsheikh-Ali, AA, Karas, RH. Assessment of peripheral vascular endothelial function in the ambulatory setting. Vasc Med 2007; 12: 13–16.Google Scholar
8. Rubinshtein, R, Kuvin, JT, Soffler, M, et al. Assessment of endothelial function by non-invasive peripheral arterial tonometry predicts late cardiovascular adverse events. Eur Heart J 2010; 31: 1142–1148.Google Scholar
9. Targonski, PV, Bonetti, PO, Pumper, GM, Higano, ST, Holmes, DR Jr., Lerman, A. Coronary endothelial dysfunction is associated with an increased risk of cerebrovascular events. Circulation 2003; 107: 2805–2809.Google Scholar
10. Haller, MJ, Stein, J, Shuster, J, et al. Peripheral artery tonometry demonstrates altered endothelial function in children with type 1 diabetes. Pediatr Diabetes 2007; 8: 193–198.Google Scholar
11. Mahmud, FH, Earing, MG, Lee, RA, Lteif, AN, Driscoll, DJ, Lerman, A. Altered endothelial function in asymptomatic male adolescents with type 1 diabetes. Congenit Heart Dis 2006; 1: 98–103.Google Scholar
12. Mahmud, FH, Hill, DJ, Cuerden, MS, Clarson, CL. Impaired vascular function in obese adolescents with insulin resistance. J Pediatr 2009; 155: 678–682.Google Scholar
13. Agarwal, C, Cohen, HW, Muzumdar, RH, Heptulla, RA, Renukuntla, VS, Crandall, J. Obesity, hyperglycemia and endothelial function in inner city Bronx adolescents: a cross-sectional study. Int J Pediatr Endocrinol 2013; 18: 1–7.Google Scholar
14. Bruyndonckx, L, Hoymans, VY, Frederix, G, et al. Endothelial progenitor cells and endothelial microparticles are independent predictors of endothelial function. J Pediatr 2014; 165: 300–305.Google Scholar
15. Chen, Y, Osika, W, Dangardt, F, Gan, LM, Strandvik, B, Friberg, P. High levels of soluble intercellular adhesion molecule-1, insulin resistance and saturated fatty acids are associated with endothelial dysfunction in healthy adolescents. Atherosclerosis 2010; 211: 638–642.Google Scholar
16. Radtke, T, Khattab, K, Eser, P, Kriemler, S, Saner, H, Wilhelm, M. Puberty and microvascular function in healthy children and adolescents. J Pediatr 2012; 161: 887–891.Google Scholar
17. Bhangoo, A, Sinha, S, Rosenbaum, M, Shelov, S, Ten, S. Endothelial function as measured by peripheral arterial tonometry increases during pubertal advancement. Horm Res Paediatr 2011; 76: 226–233.Google Scholar
18. Tryggestad, JB, Thompson, DM, Copeland, KC, Short, KR. Obese children have higher arterial elasticity without a difference in endothelial function: the role of body composition. Obesity 2012; 20: 165–171.Google Scholar
19. McGill, HC Jr., McMahan, CA, Gidding, SS. Preventing heart disease in the 21st century: implications of the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) study. Circulation 2008; 117: 1216–1227.Google Scholar
20. Bruyndonckx, L, Radtke, T, Eser, P, et al. Methodological considerations and practical recommendations for the application of peripheral arterial tonometry in children and adolescents. Int J Cardiol 2013; 168: 3183–3190.Google Scholar
21. Chen, Y, Dangardt, F, Osika, W, Berggren, K, Gronowitz, E, Friberg, P. Age- and sex-related differences in vascular function and vascular response to mental stress. Longitudinal and cross-sectional studies in a cohort of healthy children and adolescents. Atherosclerosis 2012; 220: 269–274.Google Scholar
22. Matthews, DR, Hosker, JP, Rudenski, AS, Naylor, BA, Treacher, DF, Turner, RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985; 28: 412–419.Google Scholar
23. Gonzalez, J, Wood, JC, Dorey, FJ, Wren, TA, Gilsanz, V. Reproducibility of carotid intima-media thickness measurements in young adults. Radiology 2008; 247: 465–471.Google Scholar
24. Mittelman, SD, Gilsanz, P, Mo, AO, Wood, J, Dorey, F, Gilsanz, V. Adiposity predicts carotid intima-media thickness in healthy children and adolescents. J Pediatr 2010; 156: 592.e2–597.e2.Google Scholar
25. Urbina, EM, Williams, RV, Alpert, BS, et al. Noninvasive assessment of subclinical atherosclerosis in children and adolescents: recommendations for standard assessment for clinical research: a scientific statement from the American Heart Association. Hypertension 2009; 54: 919–950.Google Scholar
26. Lee, CR, Bass, A, Ellis, K, et al. Relation between digital peripheral arterial tonometry and brachial artery ultrasound measures of vascular function in patients with coronary artery disease and in healthy volunteers. Am J Cardiol 2012; 109: 651–657.Google Scholar
27. Bauer, JH. Age-related changes in the renin-aldosterone system. Physiological effects and clinical implications. Drugs Aging 1993; 3: 238–245.Google Scholar
28. Sun, D, Huang, A, Smith, CJ, et al. Enhanced release of prostaglandins contributes to flow-induced arteriolar dilation in eNOS knockout mice. Circ Res 1999; 85: 288–293.Google Scholar
29. Thijssen, DH, de Groot, P, Kooijman, M, Smits, P, Hopman, MT. Sympathetic nervous system contributes to the age-related impairment of flow-mediated dilation of the superficial femoral artery. Am J Physiol Heart Circ Physiol 2006; 291: H3122–H3129.Google Scholar
30. Braverman, IM. The cutaneous microcirculation: ultrastructure and microanatomical organization. Microcirculation. 1997; 4: 329–340.Google Scholar