The impact of metabolic syndrome on left ventricular remodeling in children

Introduction: Metabolic syndrome induces left ventri-cular remodeling, the patterns of which impact clinical outcomes. Pathological left ventricular (LV) remodeling in children with metabolic syndrome (MS) is associated with a significant increase in cardio-metabolic risk, however, data regarding the prevalence of remodeling patterns are limited.

Objective: To study the left ventricular remodeling patterns in children with metabolic syndrome.

Methods: An observational analytical cohort study. The study was conducted on 145 children (aged 10-18 years). The diagnosis of MS was established according to the International Diabetes Federation criteria. We analyzed the echocardiography and clinical-paraclinical data. Participants were stratified using LV mass index and relative wall thickness into four LV geometric patterns as recommended by American and European Society of Echocardiography: normal geometry, concentric remodeling (cLVR), concentric hypertrophy (cLVH), and eccentric (eLVH). Statistical Analysis Used – SPSS version 20. Ethical Issues – the research was approved by the Research Ethics Committee of „Nicolae Testemitanu“ State University of Medicine and Pharmacy.

Results: In terms of presence/absence of MS, 54.7% participants from the research group showed a NG, 32.1% – cLVH, 5.7% – cLVR, 7.5% – eLVH, whereas 66.3% from the control group presented NG, 25% – cLVH, 5.4% – cLVR, 3.3% – eLVH (p> 0.05). Depending on the number of MS criteria, a NG was found in 25.8% of children with 1 positive criterion, 38.7% – 2 criteria, 24.2% – 3 criteria, 11.3% – 4-5 criteria. cLVR was recor-ded in 10.0% – 4-5 MS criteria, 30.0% of cases with 1, 2 and 3 criteria. cLVH was recorded in 15.2% – 1 positive criterion, 27.3% – 2 criteria, 32.6% – 3 criteria, 24.9% – 4-5 criteria. eLVH was found in 11.7% – 1 positive cri-terion, 19.1% – 2 criteria, 27.9% – 3 criteria, 41.3% -4-5 criteria (p> 0.05). According to MS clustering, cLVR was recorded in 15.0% of subjects with WC+TG+HBP, WC+HDLc+HBP, WC+HDLc+TG+HBP, eLVH in 14.7% with WC+HDLc+HBP, WC+HDLc +TG+ HBP+ Glu and 27.9% with WC+HDLc+TG+HBP, cLVH in 18.7% of participants with WC+HDLc+HBP, 6.1% with WC+TG+HBP, WC+TG+HDLc+HBP, and in 1.6% – WC+TG +HDLc, WC+TG+Glu+HBP, WC+TG+HDLc+Glu. The LV with NG appearance had a different overall distribution, being registered in all clinical patterns (p> 0.05).

Conclusions: In conclusion, our study shows that pathological remodeling subtypes LV are quite common in children with MS. It is recommended to be implemented in clinical practice for pediatric subjects with MS evaluation of the cardiac ultrasonographic spectrum of the remodeling type of LV myocardium based on linear measurements (interventricular septum, LV posterior wall, LV EDD) subsequently by calculating the values of the LV myocardial mass index and the relative posterior wall thickness of the LV.

Note: WC – waist circumference; HDLc – High-density lipoprotein cholesterol, TG – triglycerides, HBP – high blood pressure, Glu – glucose.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)
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