Myocardial Performance Index in Childhood Onset Essential Hypertension and White Coat Hypertension

• Published in: American journal of hypertension 2016-03, Vol.29 (3), p.379-387
• Main Authors: Gupta-Malhotra, Monesha, Hamzeh, Rabih K., Poffenbarger, Tim, McNiece-Redwine, Karen, Hashmi, Syed Shahrukh
• Format: Article
• Language: English
• Subjects: Adolescent; Blood Flow Velocity; Blood Pressure Monitoring, Ambulatory; Carotid Intima-Media Thickness; Child; Cross-Sectional Studies; Diastole; Echocardiography; Echocardiography, Doppler; Essential Hypertension; Female; Heart; Heart Ventricles - diagnostic imaging; Humans; Hypertension - diagnostic imaging; Hypertrophy, Left Ventricular - diagnostic imaging; Male; Original; Systole; Ventricular Function; White Coat Hypertension - diagnostic imaging
• ISSN: 0895-7061; 1941-7225
• DOI: 10.1093/ajh/hpv123

BACKGROUND As a global measure of ventricular systolic and diastolic function, the myocardial performance index (MPI) can be an early indicator of hypertensive cardiomyopathy in children with essential hypertension (EH). METHODS Children with untreated newly diagnosed EH and white coat hypertension (WCH) by a 24-hour ambulatory blood pressure monitoring (ABPM), both groups without any identifiable etiology for the hypertension, were enrolled for the study. Echocardiograms and vascular ultrasounds for carotid artery intimal medial thickness were performed on all children prior to therapy. Diastolic function (peak E and A velocities, E/A ratio, isovolumic relaxation time, and deceleration times) and MPI were evaluated by simultaneous transmitral and transaortic spectral Doppler flow velocities. Systolic function was evaluated by shortening fraction and ejection fraction. RESULTS A cohort of 66 children (24 with EH, 42 with WCH, males 61%, median age of 13 years, range 10–17 years) were enrolled in the study. The demographic, anthropometric, laboratory tests, vascular ultrasound, and conventional echocardiographic parameters were similar between the 2 groups. There was a very small difference in MPI between the EH and WCH children (0.28 SD: 0.07 vs. 0.31 SD: 0.08, P = 0.045). However, in EH children, MPI increased by 0.14 units for every 10 unit increase in mean ABPM systolic BP (95% confidence interval: 0.03–0.25). CONCLUSIONS We found the increasing MPI was associated with increasing 24-hour mean systolic BP in children with EH. Therefore, MPI may have utility as a single, quick, noninvasive method of detection and tracking of subclinical hypertensive heart disease.