Echocardiography as a Marker of Cardiac end Organ Injury at a Young age
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PEDIATRICS (S. GIDDING, SECTION EDITOR)
Echocardiography as a Marker of Cardiac end Organ Injury at a Young age Joseph Mahgerefteh & Samuel Gidding & Leo Lopez
Published online: 2 April 2014 # Springer Science+Business Media New York 2014
Abstract Coronary heart disease and stroke are two leading causes of morbidity and mortality. Risk factors have included obesity, metabolic syndrome, hypertension, and diabetes mellitus, and they appear to influence left ventricular mass, geometry, and systolic and diastolic function as well as left atrial size. Echocardiography is a non-invasive tool to assess these effects in children and should be utilized as a preventive as well as a diagnostic modality, as measurements from echocardiography may define an intermediate phenotype between risk and clinical endpoints. Information regarding the pathophysiologic mechanisms of the echocardiographic changes, the risk for future cardiovascular morbidity and mortality, and the effects of intervention can be derived from research. Keywords Echocardiography . Pediatrics . Cardiovascular risk . Target organ damage . Obesity . Hypertension . Diabetes . Non-alcoholic fatty liver disease . Hypertrophy
Introduction Coronary heart disease and stroke are two leading causes of morbidity and mortality [1]. Cardiovascular disease (CVD) risk factors have included obesity, metabolic syndrome, This article is part of the Topical Collection on Pediatrics
J. Mahgerefteh : L. Lopez Department of Pediatrics, Albert Einstein College of Medicine and Children’s Hospital at Montefiore, Bronx, NY, USA S. Gidding Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA J. Mahgerefteh (*) Division of Pediatric Cardiology, Children’s Hospital at Montefiore, 3415 Bainbridge Avenue, Bronx, NY 10467, USA e-mail: [email protected]
hypertension, and diabetes mellitus. Accurate assessment of cardiovascular risk is a key step toward providing optimal treatment to at-risk patients. Recent evidence reveals that the presence of risk factors at a young age is often accompanied by coexisting cardiovascular abnormalities, suggesting that the problem is not only one of long-term disease risk, but rather one requiring urgent attention to prevent progressive cardiovascular damage at a young age. In addition, there is a growing body of data suggesting that these risk factors actually have a negative effect on the cardiovascular system in children. The modes of action share some common features, but there are also changes in the cardiovascular system specific to each risk factor. Echocardiography is a non-invasive tool to assess these effects as target organ injury in children and should be utilized as a preventive as well as a diagnostic modality. The 2013 ACC/AHA guidelines for assessment of cardiovascular risk in asymptomatic adults do not recommend routine echocardiography for risk assessment of congenital heart disease (CHD) in asymptomatic adults without hypertension [2]. Screening and primary prevention strategies in adults a
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