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Chowdhury S.M.,Medical University of South Carolina | Henshaw M.H.,Medical University of South Carolina | Friedman B.,NC Associates | Saul J.P.,Medical University of South Carolina | And 4 more authors.
Journal of the American Society of Echocardiography | Year: 2014

Background Racial differences in carotid intima-media thickness (cIMT) have been suggested to be associated with the disproportionally high prevalence of cardiovascular disease in black adults. The objective of this study was to evaluate the effects of cardiovascular risk factors on the racial differences seen in cIMT in obese children. Methods Obese subjects aged 4 to 21 years were recruited prospectively. Height, weight, blood pressure, fasting insulin, glucose, lipid panel, high-sensitivity C-reactive protein, and body composition by dual-energy x-ray absorptiometry were obtained. B-mode carotid imaging was analyzed by a single blinded physician. Results A total of 120 subjects (46 white, 74 black) were enrolled. Black subjects exhibited greater cIMT (0.45 ± 0.03 vs 0.43 ± 0.02 cm, P <.01) and higher lean body mass index (19.3 ± 3.4 vs 17.3 ± 3.2 kg/m2, P =.02) than white subjects. Simple linear regression revealed modest associations between mean cIMT and race (R = 0.52, P <.01), systolic blood pressure (R = 0.47, P <.01), and lean body mass (R = 0.51, P <.01). On multivariate regression analysis, lean body mass remained the only measure to maintain a statistically significant relationship with mean cIMT (P <.01). Conclusions Black subjects demonstrated greater cIMT than white subjects. The relationship between race and cIMT disappeared when lean body mass was accounted for. Future studies assessing the association of cardiovascular disease risk factors to cIMT in obese children should include lean body mass in the analysis. Copyright © 2014 by the American Society of Echocardiography. Source


Chowdhury S.M.,Medical University of South Carolina | Hijazi Z.M.,Sidra Medical and Research CenterDoha | Fahey J.T.,Yale New Haven Hospital | Rhodes J.F.,Miami Childrens Hospital | And 5 more authors.
Journal of the American Society of Echocardiography | Year: 2015

Background Speckle-tracking echocardiographic (STE) measures of right ventricular (RV) function appear to improve after transcatheter pulmonary valve implantation (TPVI). Measures of exercise function, such as ventilatory efficiency (the minute ventilation [VE]/carbon dioxide production [Vco2] slope), have been shown to be prognostic of mortality in patients who may require TPVI. The aim of this study was to evaluate the correlation between STE measures of RV function and changes in VE/Vco2 after TPVI. Methods Speckle-tracking echocardiography and cardiopulmonary exercise testing were performed at baseline and 6 months after TPVI in 24 patients from four centers. Conventional echocardiographic measures of RV function were also assessed. Echocardiographic and exercise stress test results were interpreted by single blinded observers at separate core laboratories. Results All patients demonstrated relief of pulmonary regurgitation and stenosis after TPVI. Improvements in RV longitudinal strain (-16.9 ± 3.5% vs -19.7 ± 4.3%, P < .01) and strain rate (-0.9 ± 0.4 vs. -1.2 ± 0.4 s-1, P < .01) were noted. The VE/Vco2 slope improved (32.4 ± 5.7 vs 31.5 ± 8.8, P = .03). No other significant echocardiographic or exercise changes were found. On multivariate regression, the change in VE/Vco2 was independently associated with change in RV longitudinal early diastolic strain rate (P < .001) and tricuspid A velocity (P < .001). Preintervention RV longitudinal strain was found to be a predictor of change in VE/Vco2 after TPVI (r = -0.60, P < .001). Conclusions STE measures of RV function appear to hold the potential for use as predictors of improved outcomes in patients requiring TPVI. Future studies should directly assess the prognostic significance of STE measures of RV function in this population. © 2015 American Society of Echocardiography. Source


Forsha D.,Ward Family Heart Center | Risum N.,Hvidovre Hospital | Rajagopal S.,Duke University | Dolgner S.,Duke University | And 4 more authors.
Journal of the American Society of Echocardiography | Year: 2015

Background Speckle-tracking strain is almost universally cited as being independent of angle of insonation, but there are minimal confirmatory studies, and this claim may not be consistent with the known limitations of ultrasound axial and lateral spatial resolution. The aim of this study was to assess the influence of angle and depth on longitudinal peak systolic strain (LPS). Methods Thirty-four healthy pediatric subjects (age range, 6-18 years; 47% male) with normal cardiac anatomy and good image quality were prospectively imaged. Angular comparisons of LPS were investigated by examining interangle reproducibility on the basis of one standard and one alternative image acquisition relative to intraobserver reproducibility of two standard views of the same left ventricular segments. A single-window comparison was used to evaluated septal LPS: standard apical four-chamber versus right ventricular centered four-chamber. Two paired standard and alternative window comparisons were as follows: (1) four-chamber: standard apical versus subcostal; and (2) three-chamber: standard apical versus parasternal long-axis. Results The global LPS intraobserver difference using the paired standard and alternative window comparisons was lower than the interangle difference in global LPS (-1.0 ± 0.1% vs -2.1 ± 2.4%). Intraobserver reproducibility was significantly higher than interangle reproducibility (intraclass correlation coefficient = 0.9 vs 0.29, P <.001). Similar results were found in the segmental strain analysis. Interangle reproducibility was significantly decreased compared with intraobserver reproducibility in the septal single-window comparison. Target depth assessment demonstrated a systematic bias between the near-field and far-field segments. Conclusions Echocardiographically derived LPS values were modestly dependent on angle of insonation and target depth in this pediatric population. Normal strain ranges derived from standard apical images should not be applied to strain derived from sub-costal images, off-axis apical imaging, or applications in which a standard window cannot be defined. © 2015 American Society of Echocardiography. Source


Stanford J.A.,University of Kansas Medical Center | Shuler J.M.,University of Kansas Medical Center | Fowler S.C.,University of Kansas | Stanford K.G.,University of Kansas Medical Center | And 8 more authors.
Pediatric Research | Year: 2015

Background:Neonatal jaundice resulting from elevated unconjugated bilirubin occurs in 60-80% of newborn infants. Although mild jaundice is generally considered harmless, little is known about its long-term consequences. Recent studies have linked mild bilirubin-induced neurological dysfunction (BIND) with a range of neurological syndromes, including attention-deficit hyperactivity disorder. The goal of this study was to measure BIND across the lifespan in the Gunn rat model of BIND.Methods:Using a sensitive force plate actometer, we measured locomotor activity and gait in jaundiced (jj) Gunn rats versus their nonjaundiced (Nj) littermates. Data were analyzed for young adult (3-4 mo), early middle-aged (9-10 mo), and late middle-aged (17-20 mo) male rats.Results:jj rats exhibited lower body weights at all ages and a hyperactivity that resolved at 17-20 mo of age. Increased propulsive force and gait velocity accompanied hyperactivity during locomotor bouts at 9-10 mo in jj rats. Stride length did not differ between the two groups at this age. Hyperactivity normalized, and gait deficits, including decreased stride length, propulsive force, and gait velocity, emerged in the 17-20-mo-old jj rats.Conclusion:These results demonstrate that, in aging, hyperactivity decreases with the onset of gait deficits in the Gunn rat model of BIND. Copyright © 2015 International Pediatric Research Foundation, Inc. Source


Chowdhury S.M.,Medical University of South Carolina | Hijazi Z.M.,Rush University Medical Center | Rhodes J.,Duke University | Kar S.,Cedars Sinai Medical Center | And 5 more authors.
Echocardiography | Year: 2013

Objectives To evaluate echocardiographic changes after SAPIEN valve implantation in the pulmonary position. Background The feasibility of the SAPIEN transcatheter pulmonary valve (TPV) has recently been demonstrated. We evaluated changes in pulmonary valve function and the right ventricle after SAPIEN TPV placement. Methods We evaluated echocardiograms at baseline, discharge, 1 and 6 months after TPV placement in 33 patients from 4 centers. Pulmonary insufficiency severity was graded 0-4. TPV peak and mean gradients were measured. Right ventricular (RV) size and function were quantified using routine measures derived from color, spectral, and tissue Doppler indices and two-dimensional echocardiography. Results At baseline, 94% patients demonstrated pulmonary insufficiency grade 2-4. This decreased to 12% patients at 6 months (P < 0.01). TPV peak (P < 0.01) and mean gradient (P < 0.01) decreased. RV end-diastolic area indexed to body surface area (BSA) (P < 0.01), Tricuspid regurgitation (TR) gradient (P < 0.01), and the ratio of TR jet area to BSA (P < 0.01) decreased. Tricuspid inflow peak E:A, tissue Doppler imaging (TDI): septal E' and A', TDI: tricuspid A' improved between baseline and discharge, but trended back to baseline by 6-month follow-up. Tricuspid valve annulus z-score, RV area change, tricuspid annular plane systolic excursion (TAPSE), RV dP/dt, tricuspid E:E', and TDI: tricuspid annulus E' showed no change. Conclusion Improvements in pulmonary insufficiency and stenosis, RV size, and TR gradient and severity are seen after SAPIEN TPV placement. Selected indices of RV diastolic function improve immediately after TPV implantation, but return to baseline by 6 months. RV systolic function is unchanged. © 2013, Wiley Periodicals, Inc. Source

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