Left Ventricular Diastolic Dysfunction among Youth with Obesity and History of Elevated Blood Pressure.

OBJECTIVE: To assess prevalence of and factors associated with left ventricular diastolic dysfunction (LVDD) in youth with obesity and elevated blood pressure (BP).

STUDY DESIGN: Cross-sectional analyses of baseline and follow up visits of 83 youth, 5-21 years, evaluated for overweight/obesity and elevated BP in a multidisciplinary clinic. LVDD was defined according to established adult criteria (LVDDadult ; E/A<1, E/e'>14, or e'/a'<0.8) and pediatric criteria (LVDDpeds ; E/A<10th percentile, E/e'>99th percentile, or e'/a'< 1st percentile) based on data from 103 age-sex matched healthy controls. Baseline factors associated with LVDDpeds were examined using Wilcoxon rank sum and Chi-square tests. Multiple logistic regression analyses using generalized estimating equations to account for repeated measures evaluated the associations of adiposity and BP with LVDDpeds .

RESULTS: The prevalence of LVDD ranged from 1.2-2.7% using adult criteria and 19-28% using pediatric criteria. Those with LVDDpeds were older, predominantly male and non-African American, and had higher weight, BP, BP medication use, and non-HDL cholesterol than those without LVDDpeds . DBP z-score was associated with LVDDpeds by E/A (OR 1.95, 95% CI 1.15 - 3.32, p=0.014) after adjustment for age, sex, race, BP medications and BMI z-score.

CONCLUSIONS: LVDD was present in a substantial proportion of youth with overweight/obesity and elevated BP using pediatric criteria. Those with LVDDpeds had significantly greater measures of adiposity and BP compared with those without LVDDpeds , and DBP z-score was an independent predictor of LVDDpeds by E/A. These data emphasize the importance of prevention and treatment of CVD risk factors in childhood.