Myocardial Performance Index in Childhood Onset Essential Hypertension and White Coat Hypertension.
BACKGROUND
As a global measure of ventricular systolic and diastolic function, the myocardial performance index (MPI) can be an early indicator of hypertensive cardiomyopathy in children with essential hypertension (EH).


METHODS
Children with untreated newly diagnosed EH and white coat hypertension (WCH) by a 24-hour ambulatory blood pressure monitoring (ABPM), both groups without any identifiable etiology for the hypertension, were enrolled for the study. Echocardiograms and vascular ultrasounds for carotid artery intimal medial thickness were performed on all children prior to therapy. Diastolic function (peak E and A velocities, E/A ratio, isovolumic relaxation time, and deceleration times) and MPI were evaluated by simultaneous transmitral and transaortic spectral Doppler flow velocities. Systolic function was evaluated by shortening fraction and ejection fraction.


RESULTS
A cohort of 66 children (24 with EH, 42 with WCH, males 61%, median age of 13 years, range 10-17 years) were enrolled in the study. The demographic, anthropometric, laboratory tests, vascular ultrasound, and conventional echocardiographic parameters were similar between the 2 groups. There was a very small difference in MPI between the EH and WCH children (0.28 SD: 0.07 vs. 0.31 SD: 0.08, P = 0.045). However, in EH children, MPI increased by 0.14 units for every 10 unit increase in mean ABPM systolic BP (95% confidence interval: 0.03-0.25).


CONCLUSIONS
We found the increasing MPI was associated with increasing 24-hour mean systolic BP in children with EH. Therefore, MPI may have utility as a single, quick, noninvasive method of detection and tracking of subclinical hypertensive heart disease.
Division of Pediatric Cardiology, Department of Pediatrics, Children's Memorial Hermann Hospital, The University of Texas Health Science Center, Houston, Texas, USA; Division of Pediatric Nephrology, Department of Pediatrics, Children's Memorial Hermann Hospital, The University of Texas Health Science Center, Houston, Texas, USA; moneshagupta@gmail.com.
Monesha
M
Gupta-Malhotra
Division of Pediatric Cardiology, Texas Tech University, El Paso, Texas, USA;
Rabih K
RK
Hamzeh
Division of Pediatric Nephrology, Department of Pediatrics, Children's Memorial Hermann Hospital, The University of Texas Health Science Center, Houston, Texas, USA;
Tim
T
Poffenbarger
Division of Pediatric Nephrology, Department of Pediatrics, Children's Hospital of Arkansas, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA;
Karen
K
McNiece-Redwine
Pediatric Research Center, Department of Pediatrics, The University of Texas Health Science Center, Texas, USA.
Syed Shahrukh
SS
Hashmi
D000293:Adolescent; D001783:Blood Flow Velocity; D018660:Blood Pressure Monitoring, Ambulatory; D059168:Carotid Intima-Media Thickness; D002648:Child; D003430:Cross-Sectional Studies; D003971:Diastole; D004452:Echocardiography; D015150:Echocardiography, Doppler; D000075222:Essential Hypertension; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging*; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging*; D008297:Male; D013599:Systole; D016276:Ventricular Function; D059466:White Coat Hypertension / Q000000981:diagnostic imaging*
Tei index.; blood pressure; carotid intimal medial thickness; diastolic function; echocardiogram; hypertension; left ventricular hypertrophy; systolic function