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European Journal of Pediatrics
Published in: European Journal of Pediatrics 3/2016

01-03-2016 | Original Article

Left ventricular dysfunction and subclinical atherosclerosis in children with classic congenital adrenal hyperplasia: a single-center study from upper Egypt

Authors: Kotb Abbass Metwalley, Hekma Saad Farghaly, Tahra Sherief

Published in: European Journal of Pediatrics | Issue 3/2016

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Abstract

Few studies assessed carotid artery intima-media thickness (CA-IMT) and left ventricular (LV) function in children with congenital adrenal hyperplasia (CAH) as compared to adults. This study aimed to assess carotid artery structural changes and myocardial function with CAH. The study included 32 children with classic CAH and 32 healthy children matched for age, gender, pubertal status, and socioeconomic status. Blood levels of high-sensitivity C-reactive protein (hs-CRP) and circulating endothelial cells (CECs) were measured. LV mass (LVM) and function were assessed using conventional echocardiography. Duplex ultrasonography was used to measure CA-IMT. Compared to controls, patients had higher hs-CRP and CEC concentrations (p < 0.001) and increased CA-IMT (p < 0.001), indicating vascular endothelial injury and subclinical atherosclerosis; higher LVM index (LVMI) (p < 0.001), indicating LV hypertrophy; and lower ratio of E/A wave and prolonged mitral deceleration time (DcT) and isovolumic relaxation times (IVRTs) (p < 0.001), indicating LV dysfunction. Abnormalities were marked in uncontrolled children on medical treatment. Testosterone levels were positively correlated with CA-IMT, LVMI, and DcT values.
Conclusion: This study indicates that children with CAH and enhanced androgen levels are at increased risk of vascular endothelial injury, subclinical atherosclerosis, and LV dysfunction. These findings highlight early monitoring of children with CAH for cardiovascular abnormalities.
What is known:
• There is an increased risk for cardio-metabolic abnormalities in patients with congenital adrenal hyperplasia (CAH).
• Limited studies assessed carotid artery wall thickness and left ventricular function in children with CAH as compared to adults.
What is new:
• Atherosclerotic changes, vascular endothelial injury, and left ventricular dysfunction may begin early in children with CAH.
• Children with CAH should be monitored for myocardial and vascular endothelial functions.
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Metadata
Title
Left ventricular dysfunction and subclinical atherosclerosis in children with classic congenital adrenal hyperplasia: a single-center study from upper Egypt
Authors
Kotb Abbass Metwalley
Hekma Saad Farghaly
Tahra Sherief
Publication date
01-03-2016
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Pediatrics / Issue 3/2016
Print ISSN: 0340-6199
Electronic ISSN: 1432-1076
DOI
https://doi.org/10.1007/s00431-015-2634-1

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