Assessment of Left Ventricular Mass and Hypertrophy by Cardiovascular Magnetic Resonance Imaging in Pediatric Hypertension

Supe-Markovina, Katarina; Nielsen, James C.; Musani, Muzammil H.; Panesar, Laurie E.; Woroniecki, Robert P.

doi:10.1111/jch.12808

Cited by 9 publications

(6 citation statements)

References 24 publications

(47 reference statements)

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“…21 studies show that the accuracy of electrocardiographic indexes in the diagnosis of LVH is unsatisfactory [13]. The ECG shows an area under the ROC curve of 0.55 with 14.7% sensitivity and 96.7% specificity [14] and the echocardiography shows an area under the ROC curve of 0.62 with 90% sensitivity and 25% specificity [15]. In clinical practice, echocardiography is the imaging technique of choice [16].…”

Section: Introductionmentioning

confidence: 99%

Plasma protein thiolation index (PTI) as a potential biomarker for left ventricular hypertrophy in humans

et al. 2019

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Background Left ventricular hypertrophy (LVH) has been associated with oxidative stress, although not with the protein thiolation index (PTI). This study explored the potential use of PTI as a biomarker of oxidative stress in patients with LVH. Methods We recruited 70 consecutive patients (n = 35 LVH and n = 35 non-LVH) based on an echocardiography study in our institution (left ventricular mass indexed to body surface area). Plasma levels of both S-thiolated protein and total thiols were measured as biomarkers of oxidative stress by spectrophotometry, and PTI was calculated as the molar ratio between S-thiolated proteins and the total thiol concentration. Results Values for plasma S-thiolated proteins were higher in patients with LVH than in the control group (P = 0.01). There were no differences in total thiols between the LVH group and the control group. Finally, PTI was higher in patients with LVH than in the control group (P = 0.001). The area under the ROC curve was 0.75 (95% CI, 0.63–0.86; P<0.001), sensitivity was 70.6%, and specificity was 68.6%, thus suggesting that PTI could be used to screen for LVH. A multivariable logistic regression model showed a positive association (P = 0.02) between PTI and LVH (OR = 1.24 [95% CI, 1.03–1.49]) independently of gender (OR = 3.39 [95% CI, 0.60–18.91]), age (OR = 1.03 [95% CI, 0.96–1.10]), smoking (OR = 5.15 [95% CI, 0.51–51.44]), glucose (OR = 0.99 [95% CI, 0.97–1.01]), systolic arterial pressure (OR = 1.10 [CI 1.03–1.17]), diastolic arterial pressure (OR = 0.94 [CI 0.87–1.02]), dyslipidemia (OR = 1.46 [95% CI, 0.25–8.55]), estimated glomerular filtration rate (OR = 0.98 [95% CI, 0.96–1.01]), body mass index (OR = 1.03 [95% CI, 0.90–1.10]), and valvular and/or coronary disease (OR = 5.27 [95% CI, 1.02–27.21]). Conclusions The present study suggests that PTI could be a new biomarker of oxidative stress in patients with LVH.

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Section: Introductionmentioning

confidence: 99%

Plasma protein thiolation index (PTI) as a potential biomarker for left ventricular hypertrophy in humans

et al. 2019

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“…Furthermore, CMR is used in the evaluation of congenital heart disease, ant its use has been recently reported in children and young adults on maintenance dialysis (17, 18), and renal transplant recipients (19). Our group has described the utility of CMR in overweight hypertensive children and reported reproducibility (20). However, CMR is not yet widely available, is more expensive than echocardiography (ECHO), has disadvantages such as claustrophobia and the need for sedation in small children, and the data on its utilization in general pediatric population with HTN are lacking.…”

Section: Detection Methodsmentioning

confidence: 99%

Left Ventricular Hypertrophy in Pediatric Hypertension: A Mini Review

et al. 2017

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Adults with arterial hypertension (HTN) have stroke, myocardial infarction, end-stage renal disease (ESRD), or die at higher rates than those without. In children, HTN leads to target organ damage, which includes kidney, brain, eye, blood vessels, and heart, which precedes “hard outcomes” observed in adults. Left ventricular hypertrophy (LVH) or an anatomic and pathologic increase in left ventricular mass (LVM) in response to the HTN is a pediatric surrogate marker for HTN-induced morbidity and mortality in adults. This mini review discusses current definitions, clinically relevant methods of LVM measurements and normalization methods, its epidemiology, management, and issue of reversibility in children with HTN. Pediatric definition of LVH and abnormal LVM is not uniformed. With multiple definitions, prevalence of pediatric HTN-induced LVH is difficult to ascertain. In addition while in adults cardiac magnetic resonance imaging is considered “the gold standard” for LVM and LVH determination, pediatric data are limited to “special populations”: ESRD, transplant, and obese children. We summarize available data on pediatric LVH treatment and reversibility and offer future directions in addressing LVH in children with HTN.

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“…20 In addition, the acquisition and interpretation of images, even by clinically experienced sonographers, is a challenge. 21 Furthermore, sex, body mass, and race are common confounding factors that interfere with the accurate estimation of LV mass. 22 Data from several studies have shown that LV volume and LV mass are greater in men than in women.…”

Section: Common Limitations Of Echocardiographymentioning

confidence: 99%

One Size Fits All? Ethnicity and Electrocardiographic Criteria for Cardiac Hypertrophy

Chacko

Redfearn

2018

Canadian Journal of Cardiology

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See article by Sun et al., pages 1153e1157 of this issue.The diagnosis of left ventricular hypertrophy (LVH) by means of the electrocardiogram (ECG), when complemented by imaging modalities, is a strong predictor of cardiovascular morbidity and mortality. 1 The ECG is commonly used for the diagnosis of LVH because of its wide availability and cost effectiveness. A positive ECG finding can promote further investigations and potential changes in management, whereas a negative finding can be used for reassurance. It is well recognised that the correlation of QRS voltage with anatomical LVH is not a consistent finding and is influenced by multiple confounding factors such as age, sex, race, and ethnicity. 2 Despite research that has led to the development of several ECG criteria for the diagnosis of LVH, the sensitivity and specificity in predicting the presence of anatomically validated LVH is still a concern. The most commonly used ECG criteriadsuch as the Sokolow-Lyon index, Cornell Voltage, and the Gubner and Romhilt-Estes criteriaddeliver a wide range of sensitivity (0% to 68%) and specificity (53% to 100%) 3 . Peguero et al recently described the Peguero-Lo Presti (PLP) criterion for diagnosing LVH from a regular 12-lead ECG in a retrospective single-centre study involving a small American cohort. 4 The described measure is the sum of the deepest S-wave (SD) in any single lead and the S-wave amplitude of lead V4 (SV4). When compared with the Sokolow-Lyon and Cornell voltage criteria, the SD represented the most accurate continuous single linear measurement for the diagnosis of LVH and, when combined with the SV4, had a better diagnostic accuracy. The study concluded that the PLP criterion improved on the Cornell voltage criteria with an increased sensitivity of 65% vs 35%. In this issue of Canadian Journal of Cardiology, Sun et al 5 explore validation of the PLP ECG criterion, compared with the Sokolow-Lyon voltage and Cornell criteria, in a large Chinese population. The study concluded that Cornell voltage had a relatively higher sensitivity and specificity than the PLP criterion in diagnosing echocardiographic LVH.According to the American College of Cardiology/American Heart Association/Heart Rhythm Society ECG guidelines, there are at least 36 ECG criteria for LVH. None of them is considered superior to the other, and all have low sensitivity and high specificity. The most commonly used ECG-LVH criteria are listed in Table 1. 4,6-8 Limitations of the ECG-LVH CriteriaThe ECG diagnosis of LVH is quite reliable when prominent QRS voltage is seen in conjunction with other variables such as ST segment changes, left atrial abnormality, widening of the QRS, or leftward axis. However, when the QRS voltage alone is considered, false positive and false negative results are common. This is largely because universal ECG criteria are predicated on fixed QRS voltage, which apply identical voltage cut-offs to the young and elderly, to men and women (Sokolow-Lyon criterion), and to persons with low and high body mass index...

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Assessment of Left Ventricular Mass and Hypertrophy by Cardiovascular Magnetic Resonance Imaging in Pediatric Hypertension

Cited by 9 publications

References 24 publications

Plasma protein thiolation index (PTI) as a potential biomarker for left ventricular hypertrophy in humans

Plasma protein thiolation index (PTI) as a potential biomarker for left ventricular hypertrophy in humans

Left Ventricular Hypertrophy in Pediatric Hypertension: A Mini Review

One Size Fits All? Ethnicity and Electrocardiographic Criteria for Cardiac Hypertrophy

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