DETECTION OF EARLY DIASTOLIC DYSFUNCTION BY TISSUE DOPPLER IN CHILDREN WITH CHILDHOOD-ONSET ESSENTIAL HYPERTENSION

E1636 JACC March 27, 2012 Volume 59, Issue 13

Prevention DETECTION OF EARLY DIASTOLIC DYSFUNCTION BY TISSUE DOPPLER IN CHILDREN WITH CHILDHOODONSET ESSENTIAL HYPERTENSION ACC Moderated Poster Contributions McCormick Place South, Hall A Sunday, March 25, 2012, 9:30 a.m.-10:30 a.m.

Session Title: Stiff Hearts and Stiff Vessels: The Hypertensive Patient Abstract Category: 7. Prevention: Hypertension Presentation Number: 1180-109 Authors: Ngozi Agu, Cynthia Bell, Tim Poffenbarger, Karen Redwine, J. Timothy Bricker, Monesha Gupta, University of Texas Health Science Center at Houston, Houston, TX, USA Background: To determine the presence of early diastolic dysfunction in hypertensive children as compared to normotensive children of similar age, gender and body mass index (BMI) percentile by tissue Doppler imaging (TDI). Methods: Prospectively recruited children with untreated essential hypertension and a control group with normal blood pressure (BP); both groups confirmed by casual BP and a 24 hour ambulatory BP monitoring (ABPM). Echocardiograms were performed and an average of 3-6 cardiac cycles was done for all measurements including the transmitral flow propagation velocity (Vp), TDI, and midwall shortening fraction (MWSF). Results: There were no differences in the systolic parameters or mitral valve inflow parameters as assessed by pulse wave Doppler. However, the hypertensive children had evidence of impaired LV relaxation by TDI (table). The TDI variables continued to be significant for the anterior and posterior walls after adjustment for gender, age, BMI percentile and race on multivariate analysis. Conclusions: Early diastolic dysfunction was present in the hypertensive children as indicated by statistically significant decrease in mitral annulus longitudinal motion on TDI evaluation while pulse wave Doppler parameters remained unchanged. This finding conveys the importance of evaluation of diastolic dysfunction by tissue Doppler and strict BP control in hypertensive children to prevent further target organ damage. Table 1 Demographic, clinical and echocardiography data Variables Age (years) Gender (% male) Body mass index percentile (%) Casual SBP (mmHg) Casual DBP (mmHg) ABPM SBP mean (mmHg) ABPM DBP mean (mmHg) ABPM SBP load (%) ABPM DBP load (%) LVMI (g/m2.7) Relative wall thickness Ejection fraction (%) Mid wall fractional shortening (%) Ea (anterior) (cm/s) Ea (posterior) (cm/s) Aa (anterior) (cm/s) Aa (posterior) (cm/s) Ea (average of lateral, septal, radial, inferior, anterior) (cm/s) Aa (average lateral, septal, radial, inferior, anterior) (cm/s) Ea/Aa (average lateral, septal, radial, inferior, anterior) E/ Ea (septal) E/ Ea (lateral) E/ Ea (average septal and lateral) Vp (cm/s)

Normotensive N=34 13.1 (±3.4) 65 75 (± 26) 115(± 9) 72(± 7) 114(± 12) 65(±6) 19 (±22) 11 (±11) 37.75 (±9.1) 0.357 (±0.07) 68 (±8) 18 (±3) 18.37 (±4.4) 20.89 (±5) 8.58 (±2.4) 8.03 (±2.3) 18.12 (±3.2) 7.78 (±1.5) 2.39 (±0.52) 6.59 (±1.4) 4.3 (±0.94) 2.58 (±0.54) 62.65 (±10.1)

Hypertensive N = 46 12.8 (± 2.6) 71 82(±23) 136 (±9) 79 (± 12) 126 (±9) 70 (±7) 49 (±22) 26 (±19) 42.62 (±10.3) 0.396 (±0.07) 71 (±7) 18 (±3) 16.15 (±3.9) 18.67 (±3.4) 7.7 (±2.1) 6.95 (±1.5) 16.89 (±2.6) 7.22 (±1.5) 2.45 (±0.66) 7.23 (±1.8) 4.95 (±1.25) 2.91 (±0.68) 67.0 (±15.1))

p value 0.46 0.67 0.09 <0.0001 0.0011 <0.0001 0.0003 <0.0001 <0.001 0.046 0.01 0.07 0.3 0.0246 0.0353 0.0413 0.0431 0.07 0.07 0.8 0.07 0.003 0.009 0.39