[Ultrasonographic evaluation of atherosclerotic changes in carotid and brachial arteries in obese and hypertensive children].
According to very well documented onset of atherosclerosis in early childhood, scientists are looking for good diagnostic methods for evaluating first changes in arterial blood vessels noninvasively. We want to know more about pathogenetic mechanisms and about changes in vessels especially in the group of young people with risk factors of premature atherosclerosis. The role of endothelial dysfunction in the very early phase of this process is known well so far. High resolution echocardiography seems to be a good method which allows to examine arteries in children and adolescents. Because of localization, brachial and carotid arteries are a very good field for this kind of examinations. The aim of this study was the evaluation with high resolution echocardiography, selected parameters of endothelial function in obese and hypertensive children and adolescents. We measured the intimal plus medial thickness in carotid common arteries (IMT) also.


METHODS
We examined a group of 54 children (33 boys and 21 girls) aged 13-15 yr (mean 14 yr 6 months) obese or/ and with arterial hypertension. We eliminated persons with secondary reasons for these risk factors. For better analizes we devided a whole group into 3 subgroups: patients with isolated arterial hypertension (n-20), with isolated obesity (n-15) and with cumulation of both factors together (n-19). The control group consisted of 17 children (11 boys, 6 girls) in similar age. Using high resolution echocadiography, B-mode images, we measured during end diastole, distance "m-m" in brachial arteries (distance between two "m" lines which borde with media and adventitia of near and far wall of the artery) at rest, during reactive hyperemia (with increased flow causing endothelium-dependent dilatation FMD), again at rest and after sublingual administration glyceryl trinitrate (causing endothelium-independent dilatation NTGMD). Using Doppler technic we evaluated baseline flow and calculated degree of reactive hyperemia. We also measured intimal plus medial thickness in every carotid artery three times and calculated mean value. In our analysis we estimated concentrations of cholesterol, HDL-cholesterol, LDL-cholesterol and triglicerides.


RESULTS
In the whole examined group, the vessel size was larger and FMD was significantly impaired. In the group with an isolated hypertension and isolated obesity we noticed some differences but they did not achieve statistical significance. In the group with cumulation of risk factors, the "m-m" value, was significantly higher at rest, during reactive hyperemia and after medication and FMD was significantly lower. NTGMD in all subgroups was similiar to control group. We noticed higher IMT values in the whole examined group and in the subgroups compared to the control group. The highest IMT were in the case of the cumulation of hypertension and obesity. The level of triglicerides was higher in the group of isolated obesity, with obesity and hypertension and in whole examined group against control.


CONCLUSIONS
1. FMD evaluated in brachial artery, seems to be usefull in diagnosis of impaired endothelial function in young people suffering from the risks factors of athersclerosis. 2. Isolated obesity or arterial hypertension did not influence significantly on the impairing of endothelial function. 3. The degree of impairment in endothelial function is dependent on accumulation of athersclerosis risk factors (obesity and hypertension). 4. The evaluation of IMT in carotid arteries in children with obesity and hypertension, showed more advanced degree of atherosclerotic changes in this group compared to healthy controls.
Tołwińska
Joanna
J
II Klinika Chorób Dzieci Akademii Medycznej w Białymstoku. klchdz2@cksr.ac.bialystok.pl
Głowińska
Barbara
B
Urban
Mirosława
M
Pieciukiewicz
Bozena
B
D000293:Adolescent; D001161:Arteriosclerosis / Q000000981:diagnostic imaging* / Q000209:etiology; D001916:Brachial Artery / Q000000981:diagnostic imaging* / Q000473:pathology; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging* / Q000473:pathology; D016893:Carotid Stenosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D004730:Endothelium, Vascular / Q000473:pathology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications*; D008297:Male; D009765:Obesity / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D017539:Tunica Intima / Q000473:pathology; D017540:Tunica Media / Q000473:pathology; D014463:Ultrasonography