Heffernan Kevin S, Lefferts Wesley K, Atallah-Yunes Nader H, Glasgow Alaina C, Gump Brooks B
Department of Exercise Science, Syracuse University, Syracuse, NY, United States.
Division of Academic Internal Medicine, Department of Medicine, University of Illinois-Chicago, Chicago, IL, United States.
Front Pediatr. 2020 Mar 31;8:132. doi: 10.3389/fped.2020.00132. eCollection 2020.
The burden of heart failure is disproportionately higher in African Americans, with a higher prevalence seen at an early age. Examination of racial differences in left ventricular mass (LVM) in childhood may offer insight into risk for cardiac target organ damage (cTOD) in adulthood. Central hemodynamic load, a harbinger of cTOD in adults, is higher in African Americans. The purpose of this study was to examine racial differences in central hemodynamic load and LVM in African American and non-Hispanic white (NHW) children. Two hundred sixty-nine children participated in this study (age, 10 ± 1 years; = 149 female, = 154 African American). Carotid pulse wave velocity (PWV), forward wave intensity (W1) and reflected wave intensity (negative area, NA) was assessed from simultaneously acquired distension and flow velocity waveforms using wave intensity analysis (WIA). Wave reflection magnitude was calculated as NA/W1. LVM was assessed using standard 2D echocardiography and indexed to height as LVM/[height (2.16) + 0.09]. A cutoff of 45 g/m (2.16) was used to define left ventricular hypertrophy (LVH). LVM was higher in African American vs. NHW children (39.2 ± 8.0 vs. 37.2 ± 6.7 g/m (2.16), adjusted for age, sex, carotid systolic pressure and socioeconomic status; < 0.05). The proportion of LVH was higher in African American vs. NHW children (25 vs. 12 %, < 0.05). African American and NHW children did not differ in carotid PWV (3.5 ± 4.9 vs. 3.3 ± 1.3 m/s; > 0.05). NA/W1 was higher in African American vs. NHW children (8.5 ± 5.3 vs. 6.7 ± 2.9; < 0.05). Adjusting for NA/W1 attenuated racial differences in LVM (38.8 ± 8.0 vs. 37.6 ± 7.0 g/m (2.16); = 0.19). In conclusion, racial differences in central hemodynamic load and cTOD are present in childhood. African American children have greater wave intensity from reflected waves and higher LVMI compared to NHW children. WIA offers novel insight into early life origins of racial differences in central hemodynamic load and cTOD.
心力衰竭在非裔美国人中的负担格外沉重，在早年阶段的患病率就更高。研究儿童期左心室质量（LVM）的种族差异，或许能深入了解成年期心脏靶器官损害（cTOD）的风险。中心血流动力学负荷作为成年期cTOD的一个先兆，在非裔美国人中更高。本研究的目的是检验非裔美国儿童和非西班牙裔白人（NHW）儿童在中心血流动力学负荷和LVM方面的种族差异。269名儿童参与了本研究（年龄10±1岁；女性149名，非裔美国人154名）。使用波强度分析（WIA），从同时采集的扩张和流速波形中评估颈动脉脉搏波速度（PWV）、正向波强度（W1）和反射波强度（负向面积，NA）。波反射幅度计算为NA/W1。使用标准二维超声心动图评估LVM，并将其与身高进行指数化，即LVM/[身高（2.16）+0.09]。采用45 g/m（2.16）的临界值来定义左心室肥厚（LVH）。与NHW儿童相比，非裔美国儿童的LVM更高（39.2±8.0 vs. 37.2±6.7 g/m（2.16），经年龄、性别、颈动脉收缩压和社会经济状况校正；P<0.05）。非裔美国儿童中LVH的比例高于NHW儿童（25% vs. 12%，P<0.05）。非裔美国儿童和NHW儿童的颈动脉PWV无差异（3.5±4.9 vs. 3.3±1.3 m/s；P>0.05）。非裔美国儿童的NA/W1高于NHW儿童（8.5±5.3 vs. 6.7±2.9；P<0.05）。对NA/W1进行校正后，LVM的种族差异减弱（38.8±8.0 vs. 37.6±7.0 g/m（2.16）；P = 0.19）。总之，儿童期存在中心血流动力学负荷和cTOD方面的种族差异。与NHW儿童相比，非裔美国儿童的反射波产生的波强度更大，左心室质量指数更高。WIA为中心血流动力学负荷和cTOD种族差异的早期生命起源提供了新的见解。
