These results confirm an evolving epidemic of cardiovascular risk in youth, as evidenced by an increase in the prevalence of overweight and hypertension, notably among ethnic minority children.

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To determine whether hypertension and overweight status are associated with increased carotid intimal-medial thickness (cIMT) in children, vascular ultrasonography was performed in newly diagnosed hypertensive patients ( n=53) and normotensive controls ( n=33). Hypertensive subjects were identified either by referral or by systematic school-based hypertension screening. Hypertension was defined as blood pressure above the 95th percentile based on current Task Force criteria, and overweight was defined as body mass index (BMI) >25 kg/m(2). cIMT was assessed by high-resolution vascular ultrasonography of the distal common carotid artery. Hypertensive subjects had a higher cIMT than normotensive subjects (0.62 vs. 0.53 mm, P<0.00001). This difference remained significant after controlling for the effects of gender, race, age, height, weight, and BMI. Similarly, overweight subjects had a higher cIMT than normal-weight subjects (0.63 vs. 0.54 mm, P<0.0001). Subjects with both systolic and diastolic hypertension had higher cIMT than those with isolated systolic hypertension (0.67 vs. 0.60, P<0.05). cIMT showed significant positive pairwise correlation with age, height, weight, BMI, and systolic blood pressure. Among all clinical variables analyzed, cIMT was most strongly correlated with BMI ( r=0.53, P<0.001). These results provide further evidence that vasculopathy occurs in association with known cardiovascular risk factors such as hypertension and obesity during childhood.

Vascular complications affect perioperative management and outcomes following TAVI. Our findings show that these complications often require urgent surgical or endovascular repair and result in increased blood transfusions, greater length of hospital stay, and significantly increased costs. Diabetes mellitus and logistic European System for Cardiac Operative Risk Evaluation may be predictive of VAC and should be considered during TAVI patient selection.

Abstract-To determine whether systematic differences exist between hypertensive children referred for evaluation by primary care providers and children identified through community-based screening, cardiovascular risk factors and surrogate markers of hypertensive injury were compared based on subject source (referral versus screening). Children referred to a hypertension clinic for persistently elevated blood pressure were compared with children identified as hypertensive during school screening of 5102 students in Houston public schools. M-mode echocardiography of the left ventricle was performed and subsequently reviewed by 2 independent sonographers blinded to identifying subject information. Subsets of subjects also underwent carotid artery ultrasound for measurement of intimal-medial thickness, overnight urine collections for microalbuminuria, and fasting serum cholesterol, triglycerides, and glucose. Ninetyseven total subjects (54 screening and 43 referral) met inclusion criteria and had technically adequate echocardiography performed. The prevalence of left ventricular hypertrophy (LVH) was 37%. Referral subjects demonstrated significantly greater left ventricular mass index (38.8 versus 34.2 g/m 2.7 ; PϽ0.01) and a higher prevalence of LVH (49% versus 28%; PϽ0.05). Among subjects who underwent carotid ultrasound (nϭ75), carotid intimal-medial thickness was significantly higher in referral subjects (0.61 versus 0.57, PϽ0.05). When controlling for BMI z score, which was significantly higher in referral subjects, systematic differences by subject source did not persist. These findings suggest that hypertensive children who are predominantly overweight, independent of the manner in which patients come to medical attention, will manifest evidence of more severe cardiovascular disease assessed by surrogate markers such as left ventricular mass index or carotid artery intimal medial thickness. Key Words: obesity Ⅲ hypertension Ⅲ children Ⅲ echocardiography Ⅲ cardiovascular diseases A s the prevalence of primary pediatric hypertension has been increasing in association with the obesity epidemic, 1 increased attention has focused on the characterization of cardiovascular sequelae in children with elevated blood pressure. Because morbid cardiovascular events are rare except in the most severely hypertensive children, investigation has relied on surrogate markers of hypertensive injury such as left ventricular mass index (LVMI) and carotid artery intimal medial thickness (cIMT). Recent studies have shown that LVMI 2 and cIMT 3 are increased in hypertensive as compared with normotensive children and that these increases occur in parallel. 4 In hypertensive children, the reported prevalence of left ventricular hypertrophy (LVH) ranges from 10% to 38%, 5-12 depending on the echocardiography protocol used to derive LVM, the method of indexing LVM to standardize across the range of pediatric age and size, and the threshold used to define LVH in children. A recent, retrospective, multicenter study of 129 children undergo...