Elevated Blood Pressure And Cardiac Mechanics In Children And Adolescents: A Systematic Review And Meta-Analysis

Introduction: Evidence on left ventricular (LV) mechanics, assessed by speckle tracking echocardiography (STE), in children and adolescents with elevated blood pressure (BP)/hypertension is scanty. Aim: The aim of the present meta-analysis was to provide an updated information on LV systolic function phenotyped by global longitudinal strain (GLS) and LV ejection fraction (LVEF) in the setting of pediatric hypertension. Methods: Following the PRISMA guidelines, systematic searches were conducted across bibliographic databases (Pub-Med, OVID, EMBASE and Cochrane Library) to identify eligible studies from inception up to November 30th 2024. Clinical studies reporting data on LV mechanics in pediatric hypertension and controls were included. The statistical difference of the echocardiographic variables of interest between groups such as LVEF and GLS was calculated by standardized mean difference (SMD) with 95% confidence interval (CI) using random-effects models. Results: Eight studies including 719 individuals with elevated BP/hypertension and 1653 age-matched healthy controls were considered for the analysis. Pooled average LVEF values were 72.4±1.6% in the healthy control group and 72.5±1.8% in the elevated BP/hypertensive group (SMD: 0.08±0.15,CI: -0.21/0.36, p=0.60); the corresponding values of GLS were -19.6±1.1% and 18.5±0.9% (SMD:-0.96±0.25, CI: -1.46/-0.47, p< 0.0001). A parallel impairment of global circumferential strain (GCS) also emerged from pooled data of 3 studies (SMD: -0.96±0.25, CI: -1.46/-0.47, p< 0.0001). Conclusions: Our data suggest that LVEF is unable to detect early alterations in systolic function in pediatric hypertension, and the implementation of STE may be highly useful in unmasking systolic dysfunction in this setting.