Johns Hopkins University School of Medicine, Baltimore, MD.
Division of Pediatric Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD.
J Pediatr. 2021 Aug;235:130-137. doi: 10.1016/j.jpeds.2021.03.066. Epub 2021 Apr 1.
To assess prevalence of and factors associated with left ventricular diastolic dysfunction (LVDD) in youth with obesity and elevated blood pressure (BP).
This was a cross-sectional analysis of baseline and follow-up visits of 83 youth, 5-21 years, evaluated for overweight/obesity and elevated BP in a multidisciplinary clinic. LVDD was defined according to established adult criteria (LVDD; E/A < 1, E/e' > 14, or e'/a' < 0.8) and pediatric criteria (LVDD; E/A <10th percentile, E/e' >99th percentile, or e'/a' <1st percentile) based on data from 103 age-sex matched healthy controls. Baseline factors associated with LVDD were examined using Wilcoxon rank sum and χ tests. Multiple logistic regression analyses using generalized estimating equations to account for repeated measures evaluated the associations of adiposity and BP with LVDD.
The prevalence of LVDD ranged from 1.2% to 2.7% when we used adult criteria and 19% to 28% when we used pediatric criteria. Those with LVDD were older, predominantly male, and non-African American and had greater weight, BP, BP medication use, and non-high-density lipoprotein cholesterol than those without LVDD. Diastolic BP z score was associated with LVDD by E/A (OR 1.95, 95% CI 1.15-3.32, P = .014) after we adjusted for age, sex, race, BP medications, and body mass index z score.
LVDD was present in a substantial proportion of youth with overweight/obesity and elevated BP using pediatric criteria. Those with LVDD had significantly greater measures of adiposity and BP compared with those without LVDD, and diastolic BP z score was an independent predictor of LVDD by E/A. These data emphasize the importance of prevention and treatment of cardiovascular disease risk factors in childhood.
评估肥胖和血压升高的青年人群中左心室舒张功能障碍（LVDD）的患病率及相关因素。
这是对一个多学科诊所中评估超重/肥胖和血压升高的 83 名 5-21 岁青少年的基线和随访访问进行的横断面分析。LVDD 根据成人标准（LVDD；E/A<1、E/e'>14 或 e'/a'<0.8）和基于 103 名年龄和性别匹配的健康对照者数据的儿科标准（LVDD；E/A<第 10 百分位数、E/e'>第 99 百分位数或 e'/a'<第 1 百分位数）来定义。使用 Wilcoxon 秩和检验和 χ2 检验检查与 LVDD 相关的基线因素。使用广义估计方程进行的多变量逻辑回归分析，以考虑重复测量，评估肥胖和血压与 LVDD 的关系。
当我们使用成人标准时，LVDD 的患病率为 1.2%-2.7%，当我们使用儿科标准时，LVDD 的患病率为 19%-28%。与没有 LVDD 的患者相比，LVDD 患者年龄更大、主要为男性且非非裔美国人，体重、血压、血压药物使用和非高密度脂蛋白胆固醇水平更高。调整年龄、性别、种族、血压药物和体重指数 z 分数后，E/A 的舒张血压 z 分数与 LVDD 相关（OR 1.95，95%CI 1.15-3.32，P=0.014）。
使用儿科标准，肥胖和血压升高的青少年中 LVDD 的比例相当大。与没有 LVDD 的患者相比，LVDD 患者的肥胖和血压指标显著更高，E/A 的舒张血压 z 分数是 LVDD 的独立预测因子。这些数据强调了在儿童时期预防和治疗心血管疾病危险因素的重要性。
