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CLINICAL RESEARCH: PEDIATRIC CARDIOLOGY

Cardiac Markers of Pre-Clinical Disease in Adolescents With the Metabolic Syndrome

The Strong Heart Study

Marcello Chinali, MD^_*,,_*, Giovanni de Simone, MD^_*,, Mary J. Roman, MD, Lyle G. Best, MD, Elisa T. Lee, PhD, Marie Russell, MD^||, Barbara V. Howard, PhD^|| and Richard B. Devereux, MD

^_* Department of Clinical and Experimental Medicine, "Federico II" University Hospital School of Medicine, Naples, Italy
Department of Medicine, Weill Cornell Medical College, New York, New York
Missouri Breaks Industries Research, Inc., Timber Lake, South Dakota
University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
^|| MedStar Research Institute, Washington, DC

Manuscript received March 5, 2008; accepted April 5, 2008.

^_* Reprint requests and correspondence: Dr. Marcello Chinali, Echocardiography Laboratory, Department of Clinical and Experimental Medicine, "Federico II" University Hospital; Ed. 1, Via Sergio Pansini 5, 80131, Napoli, Italy (Email: mchinali{at}unina.it).

Objectives: Our aim was to evaluate the impact of metabolic syndrome (MetS) on cardiac phenotype in adolescents.

Background: A high prevalence of MetS has been reported in adolescents.

Methods: Four hundred forty-six nondiabetic American Indian adolescents (age 14 to 20 years, 238 girls) underwent clinical evaluation, laboratory testing, and Doppler echocardiography. Age- and gender-specific partition values were used to define obesity and hypertension. Metabolic syndrome was defined according to Adult Treatment Panel III criteria, modified for adolescents. Left ventricular (LV) hypertrophy and left atrial (LA) dilation were identified using age- and gender-specific partition values.

Results: One hundred eleven participants met criteria for MetS. They had a similar age and gender distribution as non-MetS participants. Analysis of covariance, controlling for relevant confounders, demonstrated that participants with MetS had higher LV, LA, and aortic root diameters, higher LV relative wall thickness, and greater LV mass index. Accordingly, MetS participants showed higher prevalences of LV hypertrophy (43.2% vs. 11.7%) and LA dilation (63.1% vs. 21.9%, both p < 0.001) compared with non-MetS participants. In addition, MetS was associated with a reduction in midwall shortening, lower transmitral mitral early to atrial peak velocity ratio, and mildly prolonged mitral early deceleration time (all p < 0.05). In multiple regression analysis, independently of demographics, obesity, blood pressure, and single metabolic components of MetS, clustered MetS was associated with a 2.6-fold higher likelihood of LV hypertrophy and a 2.3-fold higher likelihood of LA dilation (both p 0.02).

Conclusions: In a population sample of adolescents, MetS is associated with higher prevalences of LV hypertrophy and LA dilation and with reduced LV systolic and diastolic function, independently of individual MetS components.

Key Words: children • hypertension • obesity • left ventricular hypertrophy • left atrium • echocardiography • population study

Abbreviations and Acronyms   BMI = body mass index   CI = confidence interval   CV = cardiovascular   HDL-C = high-density lipoprotein cholesterol   LA = left atrium/atrial   LV = left ventricle/ventricular   MetS = metabolic syndrome   OR = odds ratio   RWT = relative wall thickness   RWTa = relative wall thickness age-adjusted

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