ESPN 50th Annual Meeting

ESPN 2017


 
Evaluation of Changes in Myocardial Mechanics in Children During Treatment of Malignant Hypertension
S. ALBORIKAN 1 K. PUSHPARAJAH 2 M.D. SINHA 3 J. SIMPSON 2

1- KING FAHAD SPECIALIST HOSPITAL, CARDIOLOGY DEPARTMENT, DAMMAM, SAUDI ARABIA
2- DEPARTMENT OF PAEDIATRIC CARDIOLOGY, EVELINA LONDON CHILDRENS HOSPITAL, LONDON, UNITED KINGDOM
3- DEPARTMENT OF PAEDIATRIC NEPHROLOGY, EVELINA LONDON CHILDRENS HOSPITAL, LONDON, UNITED KINGDOM
 
Introduction:

The aims of this study were to evaluate the influence of malignant hypertension (MHT) on left ventricular mass and mechanics using advanced echocardiographic techniques to quantify changes in left ventricular (LV) adaptation following management of hypertension.

Material and methods:

Children with MHT ≤16 years of age were identified. Left ventricular assessment was performed retrospectively using M-mode and two-dimensional echocardiography (2DE), in addition to 2D and 3D speckle tracking echocardiography (STE). Hypertension was defined according to the Fourth Report of the National Blood Pressure Education Program. LV mass (LVM) was calculated by Devereux formula and indexed to height (g/m2.7). Left ventricular hypertrophy (LVH) was defined as indexed LVM (LVMI) for height z-scores>1.64SD.

Results:

37 patients (age 9±6, years) with mean glomerular filtration rate (82.11±34.9 ml/min/1.73m²) and mean SBP z-scores (6.25±2.82), showed abnormal LVM and mechanics at presentation. The mean LVMI z-score was 2.1±2.4, with 22 patients (62%) exhibiting LVH at presentation. There were significant changes for 2DSTE longitudinal strain (LS) (-14.82±4.2 vs.-20.74±2.8, %; p<0.001) and circumferential strain (CS) (-13.74±5.5 vs.-20.65±5.2, %; p<0.001) between baseline and last visit. Similarly, significant changes were observed in 3DSTE LS (p 0.002), CS (p0.020) and radial strain (RS) (p.0.004). LVMI z-scores showed significant reduction (2.1±2.4 vs.01±2.1; p<0.001) over time. These changes though were not related to extent of reduction in the blood pressure despite relatively strong positive association (r²=.6; p0.65). Adjustment for potential confounders (heart rate and type of antihypertensive medication) has changed the strength of association, but did not reach statistical significance.

Conclusions:

Abnormal indices of LV mass and mechanics are evident in children with MHT with changes reversible on management of blood pressure. It is possible that other factors such as class of anti-hypertensive agent have an impact on LVM and deformation beyond reduction of blood pressure alone.