Format

Send to

Choose Destination
Hypertension. 2017 Dec;70(6):1193-1200. doi: 10.1161/HYPERTENSIONAHA.117.10040. Epub 2017 Oct 3.

Cardiovascular Structure and Function in Children With Middle Aortic Syndrome and Renal Artery Stenosis.

Author information

1
From the Department of Medicine (R.K.R.), Division of Cardiology, Labatt Family Heart Center, Hospital for Sick Children (C.S., W.H., L.M.), Division of Nephrology, Hospital for Sick Children (M.M.-A., V.L., S.R., R.S.P.), Department of Surgery (A.J.L.), and Division of Image Guided Therapy, Department of Diagnostic Imaging, Hospital for Sick Children (J.A.), University of Toronto, Ontario, Canada; Child Health Evaluative Sciences, Research Institute (R.K.R., R.S.P.) and Division of Urology (A.J.L.), Hospital for Sick Children, Toronto, Ontario, Canada; and Department of Medicine, University Health Network, Toronto, Ontario, Canada (L.M., R.S.P.).
2
From the Department of Medicine (R.K.R.), Division of Cardiology, Labatt Family Heart Center, Hospital for Sick Children (C.S., W.H., L.M.), Division of Nephrology, Hospital for Sick Children (M.M.-A., V.L., S.R., R.S.P.), Department of Surgery (A.J.L.), and Division of Image Guided Therapy, Department of Diagnostic Imaging, Hospital for Sick Children (J.A.), University of Toronto, Ontario, Canada; Child Health Evaluative Sciences, Research Institute (R.K.R., R.S.P.) and Division of Urology (A.J.L.), Hospital for Sick Children, Toronto, Ontario, Canada; and Department of Medicine, University Health Network, Toronto, Ontario, Canada (L.M., R.S.P.). rulan.parekh@sickkids.ca.

Abstract

Middle aortic syndrome (MAS) is a narrowing of the abdominal aorta, often in conjunction with renal artery stenosis (RAS). Structure and function of the cardiovascular system are not well understood. In a prospective cross-sectional study, 35 children with MAS or RAS or both (MAS/RAS) were compared with 140 age-, sex-, and body surface area-matched healthy children. Vascular assessment included carotid intima-media thickness and carotid distensibility using B-mode ultrasound and central and peripheral pulse wave velocities using applanation tonometry. Left ventricular structure and function were assessed by 2-dimensional and speckle-tracking echocardiography. Children with MAS or RAS were 12.5±3.0 years old at enrollment, and 50% were men. Carotid intima-media thickness (0.54±0.10 versus 0.44±0.05 mm; P<0.001) and central pulse wave velocities (5.58±1.83 versus 5.00±0.90 m/s; P=0.01) were significantly higher in children with disease compared with healthy children; however, after adjustment for systolic blood pressure z score, only carotid intima-media thickness remained significantly higher in the MAS/RAS group compared with the controls (β=0.07 [0.03, 0.10]). Peripheral pulse wave velocities and carotid distensibility were normal. Children with disease had significantly increased left ventricular mass and changes in diastolic function (lower E/a ratio and lower e' velocities). Systolic parameters, including ejection fraction, global longitudinal and circumferential strain, were similar to controls. Our findings demonstrate that children with MAS or RAS have evidence of carotid and left ventricular remodeling, without peripheral arterial involvement, which suggests a localized disease process. Left ventricular systolic function is preserved; however, subtle changes in diastolic function are observed. Carotid vessel changes are consistent with a 5- to 10-year aging, which underscores the importance of blood pressure control.

KEYWORDS:

carotid intima-media thickness; pulse wave analysis; renal artery stenosis; vascular disease; ventricular function, left

[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Atypon
Loading ...
Support Center