Abstract 14098: Abnormal Carotid Artery Dynamics and Endothelial Function in Pre-Pubertal Obese Children With Normal Echocardiograms
PURPOSE: Childhood obesity has reached epidemic levels. The objective of this study was to determine the severity and predictors of its associated cardiovascular co-morbidities in pre-pubertal obese children.
METHODS: We evaluated 24 healthy pre-pubertal children between ages 7 to 12 years. Eighteen patients had a BMI percentile above 85th while six children with a BMI between 5-85th percentile served as a control group. During a single fasting office visit, standard biometrics, vital signs, metabolic markers (glucose, HbA1c, lipid panel, leptin, hs-CRP, BNP) were obtained. Additionally, complete echocardiogram, carotid intimal-media thickness (CIMT), carotid two-point speckle-tracking strain imaging (C2PS), and brachial artery flow-mediated vasodilation (FMD) were performed.
RESULTS: Obese children had higher diastolic blood pressure (DBP) z-scores (0.35 [-0.4, 1.1] vs. -0.3 [-0.28, -0.06], p <0.02), but there were no differences in systolic blood pressure (SBP), mean blood pressure, pulse pressure or heart rate. CIMT was not significantly different between the two groups, but obese children had significant exaggerated carotid artery late systolic strain rate (-0.81 ± 1.2/sec vs. -0.35 ± 0.1/sec, p <0.05). FMD was also markedly impaired in obese children (6.7 ± 3.7% vs. 11.4 ± 2.6%, p<0.02), and correlated with local artery stiffness index (r2=0.52, p=0.02), and ln hs-CRP (r2=0.31, p=0.006). LV end diastolic dimension, end systolic dimension and mass were increased in obese children, but no differences in systolic function, diastolic function, or cardiac index were observed. In multivariate regression, fasting glucose, HbA1c, triglycerides, hs-CRP and SBP were independent predictors of vascular disease after controlling for BMI.
CONCLUSION: Pre-pubertal obese children have markedly impaired muscular artery endothelial function, elastic distention, and recoil that correlate with manifestation of metabolic syndrome. FMD and C2PS appear to be more sensitive surrogates of vascular disease than CIMT and may be valuable in monitoring interventions designed to prevent vascular complications. However, the mechanisms and progression of arterial dysfunction in this population requires further investigation.
- © 2013 by American Heart Association, Inc.