Left Ventricular Diastolic Dysfunction Among Youth with Obesity and History of Elevated Blood Pressure

Objective: To assess prevalence of and factors associated with left ventricular diastolic dysfunction (LVDD) in youth with obesity and elevated blood pressure (BP). Study design: This was a cross-sectional analysis of baseline and follow-up visits of 83 youth, 5-21 years, evaluated for overweight/obesity and elevated BP in a multidisciplinary clinic. LVDD was defined according to established adult criteria (LVDD_adult; E/A < 1, E/e′ > 14, or e′/a′ < 0.8) and pediatric criteria (LVDD_peds; E/A <10th percentile, E/e′ >99th percentile, or e′/a′ <1st percentile) based on data from 103 age-sex matched healthy controls. Baseline factors associated with LVDD_peds were examined using Wilcoxon rank sum and χ² tests. Multiple logistic regression analyses using generalized estimating equations to account for repeated measures evaluated the associations of adiposity and BP with LVDD_peds. Results: The prevalence of LVDD ranged from 1.2% to 2.7% when we used adult criteria and 19% to 28% when we used pediatric criteria. Those with LVDD_peds were older, predominantly male, and non-African American and had greater weight, BP, BP medication use, and non–high-density lipoprotein cholesterol than those without LVDD_peds. Diastolic BP z score was associated with LVDD_peds by E/A (OR 1.95, 95% CI 1.15-3.32, P = .014) after we adjusted for age, sex, race, BP medications, and body mass index z score. Conclusions: LVDD was present in a substantial proportion of youth with overweight/obesity and elevated BP using pediatric criteria. Those with LVDD_peds had significantly greater measures of adiposity and BP compared with those without LVDD_peds, and diastolic BP z score was an independent predictor of LVDD_peds by E/A. These data emphasize the importance of prevention and treatment of cardiovascular disease risk factors in childhood.