Mahgerefteh Joseph, Linder Jarrett, Silver Ellen J, Hazin Penelope, Ceresnak Scott, Hsu Daphne, Lopez Leo
Division of Pediatric Cardiology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, 3415 Bainbridge Avenue, Bronx, NY, 10467, USA.
Pediatr Cardiol. 2016 Aug;37(6):993-1002. doi: 10.1007/s00246-016-1380-0. Epub 2016 Mar 31.
Obesity and left ventricular hypertrophy (LVH) have been identified as independent risk factors for cardiovascular events. The definition of LVH depends on the geometric algorithm used to calculate LV mass (LVM) by echocardiography and the method used to normalize LVM for body size. This study evaluates the effect of these methods on the prevalence of LVH in obese children. LVM for 109 obese and 109 age-matched non-obese children was calculated using M-mode or two-dimensional echocardiography (2DE). LVM was then normalized to height 2.7 as indexed LVM (LVMI), to body surface area (BSA), height, and lean body mass (LBM) as LVM Z-scores. LVH was defined as LVMI >95th ‰ using age-specific normal reference values or LVM Z-scores ≥2. The prevalence of LVH by LVMI and LVM Z-scores was compared. There was a correlation between LVM determined by M-mode and by 2DE (R (2) = 0.91), although M-mode LVM was greater than 2DE LVM. However, the difference between these values was greater in obese children than in non-obese children. Based on the method of normalization, the prevalence of LVH among obese children was 64 % using LVMI, 15 % using LVM Z-scores for height, 8 % using LVM Z-scores for BSA and 1 % using LVM Z-scores for LBM. Height-based normalization correlates with obesity and hypertension. The methods used to measure and normalize LVM have a profound influence on the diagnosis of LVH in obese children. Further study is needed to determine which method identifies children at risk for cardiovascular morbidity and mortality.
肥胖和左心室肥厚（LVH）已被确定为心血管事件的独立危险因素。LVH的定义取决于用于通过超声心动图计算左心室质量（LVM）的几何算法以及用于将LVM按体型进行标准化的方法。本研究评估了这些方法对肥胖儿童LVH患病率的影响。使用M型或二维超声心动图（2DE）计算了109名肥胖儿童和109名年龄匹配的非肥胖儿童的LVM。然后将LVM标准化为身高2.7作为LVM指数（LVMI），标准化为体表面积（BSA）、身高和去脂体重（LBM）作为LVM Z评分。使用年龄特异性正常参考值将LVH定义为LVMI>第95百分位数，或LVM Z评分≥2。比较了通过LVMI和LVM Z评分得出的LVH患病率。通过M型和2DE测定的LVM之间存在相关性（R（2）=0.91），尽管M型LVM大于2DE LVM。然而，肥胖儿童中这些值的差异大于非肥胖儿童。基于标准化方法，肥胖儿童中使用LVMI时LVH患病率为64%，使用身高LVM Z评分时为15%，使用BSA LVM Z评分时为8%，使用LBM LVM Z评分时为1%。基于身高的标准化与肥胖和高血压相关。用于测量和标准化LVM的方法对肥胖儿童LVH的诊断有深远影响。需要进一步研究以确定哪种方法能识别出有心血管发病和死亡风险的儿童。
