Evaluation of left ventricular function in overweight children and teenagers with arterial hypertension and white coat hypertension.

BACKGROUND: Obesity in childhood is strongly associated with elevated arterial blood pressure and risk of hypertension. The aim of the study was the evaluation of left ventricular (LV) function in hypertensive and white coat hypertensive overweight children and teenagers. METHODS: The study group consisted of 74 overweight patients aged 10.3 ± 3.1 years (range: 6-16 years) diagnosed as hypertensive in standard blood pressure measurement. The control group consisted of 31 normotensive and normoweight children. Ambulatory blood pressure monitoring (ABPM) and echocardiographic assessment of the LV mass and function were performed in all participants. RESULTS: Using ABPM hypertension was confirmed in 20 (27%) children. In the 54 (73%) remaining children white coat hypertension was diagnosed. The analysis of echocardiographic parameters revealed higher LV mass index (LVMI) in hypertensive overweight than in normotensive normoweight children (47.5 ± 9.2 g/m2.7 vs. 39.8 ± 12.1 g/m2.7; p < 0.05) and no difference between overweight hypertensive and white coat hypertension-hypertensive groups. The deceleration time of mitral early filling (DCT) was longer in hypertensive normoweight children than in normotensive overweight patients (219.5 ± 110.3 ms vs. 197.8 ± 65.8 ms; p < 0.05). A significant correlation between systolic blood pressure load (SBPL) and DCT (r = 0.57) and moderate correlation between SBPL and LVMI (r: 0.48) as well as between LVMI and isovolumetric relaxation time (r = 0.37) were found. CONCLUSIONS: In overweight children the diagnosis of hypertension should be confirmed in ABPM because of the high prevalence of white coat hypertension. Periodic echocardiographic examinations should be recommended in overweight children with increased SBPL and decreased systolic nocturnal deep because of the possibility of LV function impairment.

Postnatal Evaluation of Congenital Chest Pathologies Using a Low-Dose Computed Tomography (CT) Protocol - a Pictorial Review.

Computed tomography with its excellent spatial and temporal resolution remains a valuable diagnostic modality in pediatrics. On the other hand an increasing attention has been placed on the radiation risks associated with CT imaging, especially in children. In recent years, many advances in CT hardware and software, for example, automatic exposure control tools and iterative reconstruction techniques, have allowed for a reduction of applied radiation doses while maintaining image quality. The purpose of this paper is to present our protocol for chest CT imaging in the youngest age group, together with a pictorial review of congenital pathologies of the chest, and to emphasize factors that optimize postnatal CT imaging in infants. In our opinion, modern CT imaging with the use of dose reduction techniques and iterative reconstructions allows for a proper visualization of chest pathologies in small children, which has no influence on observer performance. The presented review of low-dose diagnostic images of a wide spectrum of congenital pathologies may serve as an example of routine utilization of the current concepts in pediatric CT optimization.

Assessment of left ventricular diastolic function in children after successful repair of aortic coarctation.

The purpose of the study was an assessment of left ventricular diastolic function in children after the successful repair of aortic coarctation (CoA). The prospective study concerned 32 pediatric patients after the CoA surgery. Tissue Doppler imaging parameters including strain and strain rate and the conventional echocardiographic indexes were analyzed in patients and healthy controls. Analysis of mitral annulus velocities, E-E' ratio, strain, and strain rate of left ventricular mid-cavity segments and conventional indexes of mitral inflow showed the worsening of left ventricular diastolic mechanics in the study group compared to healthy controls. The E/E' ratio was significantly higher in the study group compared to the control group (8.30 ± 3.24 vs. 6.95 ± 1.36; p < 0.05). The early diastolic strain rate to late diastolic strain rate ratio as well as early to late diastolic strain ratio of the left ventricular mid-cavity segments were significantly lower in the study group compared to healthy controls (1.81 ± 0.63 vs. 3.74 ± 1.53; p < 0.001 and 1.20 ± 0.49 vs. 3.41 ± 1.26; p < 0.001). No differences of the pulmonary venous flow parameters between those two groups were observed. The left ventricular diastolic mechanics in hypertensive patients after CoA repair did not differ from normotensive subjects. Hypertensive and normotensive children after surgical repair of CoA are found to have worsening of the left ventricular diastolic mechanics suggesting the impairment of the active myocardial relaxation.

[Therapeutic difficulties in a 3 year-old boy with Kawasaki disease]. / Problemy terapeutyczne u 3-letniego chlopca z choroba Kawasaki.

A case of a three year-old by with delayed diagnosis of disease is presented. Treatment with immunoglobulins and methylpreduisolone was affective, however, no regression in coronary artery lesions was observed. The diagnosis and treatment of Kawasaki disease are discussed.

Assessment of left ventricular systolic function using tissue Doppler imaging in children after successful repair of aortic coarctation.

UNLABELLED: SUMMARY AIM: Assessment of left ventricular systolic function in children after the successful repair of aortic coarctation using tissue Doppler imaging (TDI). METHODS: The study group consisted of 32 patients (mean age 12.0 +/- 4.2 years) after the aortic coarctation repair. The TDI parameters and the conventional echocardiographic endocardial and midwall indices of the left ventricular systolic function were analysed and compared with the results obtained from 34 healthy children. RESULTS: The systolic mitral annulus motion velocity, systolic myocardial velocity of the medial segment of the left ventricular septal wall, left ventricular strain and Strain Rate (SR) in the study group were significantly higher than in the control group, respectively: 6.92 +/- 0.75 cm s(-1) versus 6.45 +/- 0.83 cm s(-1); 5.82 +/- 1.03 cm s(-1) versus 5.08 +/- 1.11 cm s(-1); -28.67 +/- 6.04% versus -22.53 +/- 6.44% and -3.20 +/- 0.76 s(-1) versus -2.39 +/- 0.49 s(-1). Except midwall shortening fraction the conventional endocardial and midwall echocardiographic indices in the study group were significantly higher in comparison to the healthy controls. The left ventricular systolic meridional fibre stress and end-systolic circumferential wall stress did not differ between the examined groups. There were no differences of the TDI or conventional parameters between hypertensive and normotensive patients. CONCLUSIONS: Left ventricular systolic performance in children after the surgical repair of aortic coarctation reveals tendency to rise in late follow-up despite a satisfactory result after surgery. Higher systolic strain and SR in children treated due to coarctation of the aorta may suggest the increased preserved left ventricular performance despite normalization of afterload.

Usefulness of ambulatory blood pressure monitoring in diagnosis of arterial hypertension in children and adolescents.

BACKGROUND: Arterial hypertension in children and adolescents is an important medical problem with a prevalence rising over the last ten years from 1 to 4.5%. AIM: To assess the usefulness of ambulatory blood pressure monitoring (ABPM) in diagnosis of arterial hypertension in children and adolescents. METHODS: Two hundred and twelve children with elevated blood pressure (BP) and 81 healthy controls participated in this study. In all children from the study and control groups standard BP measurement and ABPM were performed. RESULTS: With the use of standard BP measurement, 168 (79.2%) children were diagnosed as hypertensive and the remaining 44 (20.8%) as prehypertensive. When the ABPM was used, arterial hypertension was diagnosed in 143 (67.4%) cases and white coat hypertension in the remaining 69 (32.6%) subjects. In 7 (8.7%) control children elevated BP in ABPM was detected, and masked hypertension were diagnosed. CONCLUSIONS: 1. Ambulatory blood pressure monitoring is a useful tool in diagnosis of arterial hypertension in children and adolescents. 2. Systolic hypertension is a major form of hypertension in childhood. 3. Ambulatory blood pressure monitoring is helpful to identify patients with white coat hypertension. 4. Further studies are necessary to establish uniform indications, standards and rules for interpretation of ABPM in children and adolescents.