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Curr Hypertens Rep (2013) 15:453457
DOI 10.1007/s11906-013-0370-3
PEDIATRIC HYPERTENSION (JT FLYNN, SECTION EDITOR)
Left Ventricular Hypertrophy in Hypertensive Children and Adolescents: Predictors and Prevalence
Rae-Ellen W. Kavey
Published online: 28 July 2013# Springer Science+Business Media New York 2013
Abstract Left ventricular hypertrophy is an independent predictor of cardiovascular morbidity and mortality in adults. In children, the primary correlate of left ventricular mass (LVM) is lean body mass, but fat mass, gender and systolic blood pressure are also contributors. LVM can be estimated from echocardiographic measurements, and by indexing this allometrically to height to the 2.7 power, the left ventricular mass index (LVMI) can be calculated. LVMI optimizes detection of left ventricular hypertrophy with established normal curves for children from birth to 18 years. In children with sustained hypertension, 841 % have LVMI above the 95th percentile and in 1015.5 % of these, LVMI is elevated above levels associated with increased mortality in adults. The presence of obesity is associated with higher LVMI than is found in children with hypertension alone. In children with chronic kidney disease, left ventricular hypertrophy develops relatively early and becomes more prevalent as kidney function decreases. In summary, left ventricular hyper-trophy is a sensitive marker of target organ damage in children with BP elevation, obesity and chronic kidney disease providing important management information.
Keywords Left ventricular hypertrophy . LVH . Left ventricular mass . LVM . Left ventricular mass index . LVMI . Blood pressure . BP . Hypertension . Child . Adolescent . Chronic kidney disease . CKD . Pediatric . Target organ damage . End organ damage
Introduction: Left Ventricular Hypertrophy and Assessment of Left Ventricular Mass
Left ventricular hypertrophy (LVH) is an established independent predictor of cardiovascular morbidity and mortality, regardless of the stimulus to development of LVH [1]. The pathophysiologic basis for CV risk includes myocardial supplydemand mismatch secondary to increased myocardial oxygen consumption with reduced coronary flow reserve, predisposing to subendocardial ischemia, ventricular arrhythmias and sudden death. Echocardiography provides noninvasive, serial assessment of left ventricular mass (LVM) and ultrasound studies have allowed exploration of the factors that contribute to left ventricular hypertrophy.
LVM in adults correlates directly with height, lean body mass, obesity, blood pressure, diabetes and the metabolic syndrome among other factors [2, 3]....