title: Detection of early diastolic alterations by tissue Doppler imaging in untreated childhood-onset essential hypertension.
abstract: The aim of the study was to determine the presence of preclinical diastolic dysfunction in hypertensive children relative to normotensive children by Tissue Doppler Imaging (TDI). We prospectively enrolled children with untreated essential hypertension in absence of any other disease and a matched healthy control group with normal blood pressure (BP); both groups confirmed by clinic BP and a 24-hour ambulatory BP monitoring. Echocardiographic diastolic parameters were determined using spectral transmitral inflow Doppler, flow propagation velocity, TDI, and systolic parameters were determined via midwall shortening fraction and ejection fraction. A total of 80 multiethnic children were prospectively enrolled for the study: 46 hypertensive (median age, 13 years; 72% males) and 34 control (median age, 14 years; 65% males). The only echocardiography parameters that had a statistically significant change compared with the control children, were regional mitral Ea, Aa, and the E/Ea ratio by TDI. In comparison with controls, hypertensive children had lower Ea and Aa velocities of anterior and posterior walls and higher lateral wall E/Ea ratio. The decrease in posterior wall Ea and Aa remained significant after adjustment for gender, age, body mass index, ethnicity, and left ventricular hypertrophy on multivariate analysis. The lateral and septal wall E/Ea ratios correlated significantly with fasting serum insulin levels on similar multivariate analysis. Decreased regional TDI velocities were seen with preserved left ventricular systolic function even when other measures of diastolic dysfunction remained unchanged in untreated hypertensive children. Hypertension and serum insulin levels had strong associations with preclinical diastolic alterations in children.
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Children's Memorial Hermann Hospital, The University of Texas Medical School, Houston, TX.
authors.forename: Ngozi C
authors.initials: NC
authors.lastname: Agu
authors.affiliation: Division of Pediatric Nephrology, Department of Pediatrics, Children's Hospital of Arkansas, University of Arkansas for Medical Sciences, Little Rock, AR; Division of Pediatric Nephrology, Department of Pediatrics, Children's Memorial Hermann Hospital, The University of Texas Medical School, Houston, TX.
authors.forename: Karen
authors.initials: K
authors.lastname: McNiece Redwine
authors.affiliation: Division of Pediatric Nephrology, Department of Pediatrics, Children's Memorial Hermann Hospital, The University of Texas Medical School, Houston, TX.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Bell
authors.affiliation: Wyle Science, Technology, and Engineering, Cardiovascular Laboratory at National Aeronautics and Space Administration Johnson Space Center, Houston, TX.
authors.forename: Kathleen Marie
authors.initials: KM
authors.lastname: Garcia
authors.affiliation: Wyle Science, Technology, and Engineering, Cardiovascular Laboratory at National Aeronautics and Space Administration Johnson Space Center, Houston, TX.
authors.forename: David S
authors.initials: DS
authors.lastname: Martin
authors.affiliation: Division of Pediatric Nephrology, Department of Pediatrics, Children's Memorial Hermann Hospital, The University of Texas Medical School, Houston, TX.
authors.forename: Tim S
authors.initials: TS
authors.lastname: Poffenbarger
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Children's Memorial Hermann Hospital, The University of Texas Medical School, Houston, TX.
authors.forename: John T
authors.initials: JT
authors.lastname: Bricker
authors.affiliation: Division of Pediatric Nephrology, Department of Pediatrics, Children's Memorial Hermann Hospital, The University of Texas Medical School, Houston, TX.
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Portman
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Children's Memorial Hermann Hospital, The University of Texas Medical School, Houston, TX; Division of Pediatric Nephrology, Department of Pediatrics, Children's Hospital of Arkansas, University of Arkansas for Medical Sciences, Little Rock, AR. Electronic address: Monesha.gupta@uth.tmc.edu.
authors.forename: Monesha
authors.initials: M
authors.lastname: Gupta-Malhotra
mesh_terms: D000293:Adolescent; D001783:Blood Flow Velocity / Q000502:physiology*; D016022:Case-Control Studies; D002648:Child; D003971:Diastole / Q000502:physiology*; D004452:Echocardiography; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000503:physiopathology; D007328:Insulin / Q000097:blood; D008297:Male; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000502:physiology; D015999:Multivariate Analysis; D011446:Prospective Studies; D013318:Stroke Volume / Q000502:physiology; D013599:Systole / Q000502:physiology; D018615:Ultrasonography, Doppler, Color; D018617:Ultrasonography, Doppler, Pulsed
chemical_list: D007328:Insulin
keywords: Echocardiography; diastole; hypertension; insulin; pediatrics