Extremes of LV mass index and of relative thickness of the left ventricle posterior wall in children with MS
Pavel Golovin1, Veronica Esanu2, Valeriu Esanu3

1 Prodiab, -, Chisinau, Republic of Moldova.
2 Nicolae Testemitanu State University of Medicine and Pharmacy, Pediatrics, Chisinau, Republic of Moldova.
3 Nicolae Testemitanu State University of Medicine and Pharmacy, Endocrinology, Chisinau, Republic of Moldova

Background:

	Metabolic syndrome (MS) includes a group of severe disorders and is attesting when are present at least 3 of the following: hypertension, abdominal obesity, insulin resistance and dyslipidemia. At this complex can be added: proinflammatory and prothrombotic state, non-alcoholic hepatic steatosis and sleep apnea.
Left ventricular hypertrophy is defined by values of left ventricle myocardial mass index (LV Mass Index)  greater than 95th percentile. Depending on the values of LV Mass Index and relative thickness of the left ventricle posterior (RWT) are estimated 4 forms of left ventricle myocardial remodeling. Left ventricle has a normal aspect when LV Mass Index ≤ 95th percentile and RWT ≤ 0.44, concentric remodeling of left ventricle when LV Mass Index ≤95th percentile and RWT > 0.44, concentric hypertrophy of left ventricle when LV Mass Index  > 95th percentile and  RWT ≤ 0.44, and eccentric hypertrophy when LV Mass Index  > 95th percentile and RWT > 0.44.
	Currently, there are few data on assessment of LV Mass Index and RWT in children with metabolic syndrome.

Aim :

	Studying variations of I LV Mass Index  and RWT in children with metabolic syndrome.

Materials and methods:

	The study included 20 children with risk factors for the metabolic syndrome and with confirmed metabolic syndrome according criteria of International Diabetes Federation (IDF), aged between 10 – 17 years (average age: 14.474 ±2.458 years), ratio of girls: boys is 1:2, with free consented participating. The study group was represented by 13 children with MS and control group by 7 children with pre-MS.
	Left ventricle myocardial mass was calculated by Devereux formula, LV Mass = 0.8{1.04[([LVEDD + IVSd +PWd]3 - LVEDD3)]} + 0.6, but LV Mass Index depending on height (g/m2.7) = LV Mass /h2.7, after being compared with percentile tablets, what are accepted by American Society of Echocardiography (ASE). The relative thickness of the rear wall of left ventricle was calculated by formula RWT = 2* Posterior wall thickness at end-diastole / LV end-diastolic dimension.

Results:

	According to the criteria proposed by IDF, in 68.4% cases were confirmed MS and in 31.6% pre- MS. Average value of LV Mass was 144.78±52.49, in children with MS – 134.71±39.23 and in children pre-MS – 166.61±73.43. Average value of LV Mass Index  was 35.32±7.43, in the study group – 33.87±4.99 and in the control group – 38.46±11.03. LV Mass Index > 95th percentile was determined in 23.08% of cases in children with MS and in 33.33% in those with pre-SM. Average value of RWT was 0.37±0.04, in the study group – 0.37±0.04 and in the control group – 0.37±0.04. In the group of children with confirmed SM, 69.23% – left ventricle has a normal aspect, in 23.08% – concentric hypertrophy and in 7.69% – concentric remodelation. In the control group 66.66% left ventricle has a normal aspect, in 16.67% – eccentric hypertrophy and in 16.67% – concentric hypertrophy of left ventricle. 

Conclusions:

	This research demonstrates that changes of the left ventricle myocardium are present the same in children with MS and in those with pre-MS. This children have high cardiometabolic risk and request a therapeutic approach and intervention as early as possible and maximum effective, aiming prevention of installing of irreversible complications in adulthood.