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Effects of blood pressure percentile, body mass index, and race on left ventricular mass in children

Published online by Cambridge University Press:  06 January 2022

Michelle L. Udine Open the ORCID record for Michelle L. Udine [Opens in a new window] ,
Jonathan R. Kaltman ,
Qianxi Li ,
Jin Liu ,
Deyu Sun ,
Man Ching Cheung ,
Sam Sabouni ,
Ahmed Al Dulaimi  and
Craig Sable
Michelle L. Udine*
Affiliation:
Division of Cardiology, Children’s National Hospital, Washington, DC, USA
Jonathan R. Kaltman
Affiliation:
Division of Cardiology, Children’s National Hospital, Washington, DC, USA
Qianxi Li
Affiliation:
Philips Research North America, Cambridge, MA, USA
Jin Liu
Affiliation:
Philips Research North America, Cambridge, MA, USA
Deyu Sun
Affiliation:
Philips Research North America, Cambridge, MA, USA
Man Ching Cheung
Affiliation:
Philips Research North America, Cambridge, MA, USA
Sam Sabouni
Affiliation:
Division of Cardiology, Children’s National Hospital, Washington, DC, USA
Ahmed Al Dulaimi
Affiliation:
Division of Cardiology, Children’s National Hospital, Washington, DC, USA
Craig Sable
Affiliation:
Division of Cardiology, Children’s National Hospital, Washington, DC, USA
*
Author for correspondence: M. Udine, MD, 111 Michigan Avenue NW-WW 300, Suite 200, Washington, DC 20010, USA. Tel: (202) 476-2315; Fax: (202) 476-5700. E-mail: [email protected]
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Abstract

Objective:

To evaluate the association of systolic blood pressure percentile, race, and body mass index with left ventricular hypertrophy on electrocardiogram and echocardiogram to define populations at risk.

Study design:

This is a retrospective cross-sectional study design utilising a data analytics tool (Tableau) combining electrocardiogram and echocardiogram databases from 2003 to 2020. Customized queries identified patients aged 2–18 years who had an outpatient electrocardiogram and echocardiogram on the same date with available systolic blood pressure and body measurements. Cases with CHD, cardiomyopathy, or arrhythmia diagnoses were excluded. Echocardiograms with left ventricle mass (indexed to height2.7) were included. The main outcome was left ventricular hypertrophy on echocardiogram defined as Left ventricle mass index greater than the 95th percentile for age.

Results:

In a cohort of 13,539 patients, 6.7% of studies had left ventricular hypertrophy on echocardiogram. Systolic blood pressure percentile >90% has a sensitivity of 35% and specificity of 82% for left ventricular hypertrophy on echocardiogram. Left ventricular hypertrophy on electrocardiogram was a poor predictor of left ventricular hypertrophy on echocardiogram (9% sensitivity and 92% specificity). African American race (OR 1.31, 95% CI = 1.10, 1.56, p = 0.002), systolic blood pressure percentile >95% (OR = 1.60, 95% CI = 1.34, 1.93, p < 0.001), and higher body mass index (OR = 7.22, 95% CI = 6.23, 8.36, p < 0.001) were independently associated with left ventricular hypertrophy on echocardiogram.

Conclusions:

African American race, obesity, and hypertension on outpatient blood pressure measurements are independent risk factors for left ventricular hypertrophy in children. Electrocardiogram has little utility in the screening for left ventricular hypertrophy.

Keywords

Left ventricular hypertrophyhypertensionraceobesitypreventive cardiologyechocardiogramelectrocardiogram
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 6 , June 2022 , pp. 855 - 860
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Copyright
© The Author(s), 2022. Published by Cambridge University Press

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