Determinants of Left Ventricular Mass Among Apparently Normal Children in Enugu State
Main Article Content
Keywords
Left Ventricular Hypertrophy, Healthy Children, Prevalence, Echocardiography
Abstract
Background: The left ventricular mass (LVM) index is a very crucial index used for risk stratification among children. This work aimed to document the LVM values among children and delineate the prevalence of LVH among healthy children in Southeast Nigeria. It elicited the correlation between Left ventricular mass index (LVMI) and age, gender and height.
Methodology: This is a descriptive study involving 218 children drawn from one public and 2 private hospitals over six years. Echocardiographic measurements which assessed various parameters and indices of LVH were ascertained. The data was analyzed with the IBM SPSS statistics for windows, version 20 (IBM Corp, Chicago).
Results: The prevalence of left ventricular hypertrophy among the respondents was 5.0%. There was a strong positive correlation between left ventricular mass and surface area, (n=218, r=0.751, p<0.001). There was a very strong positive correlation between left ventricular mass and weight, which was found to be statistically significant, (n=218, r=0.755, p<0.001). There was a very strong positive correlation between left ventricular mass and BMI, which was found to be statistically significant, (n=218, r=0.34, p=0.004). There was a positive correlation between left ventricular mass and height, which was found to be statistically significant, (n=218, r=0.126, p=0.238).
Conclusion: The mean values of LVM indexed to height, BMI, surface area, and weight and compared with gender were elicited in this study. These mean normative values could be a guide for the cardiothoracic surgeon and paediatric cardiologist in some clinical decision-making.
References
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13. Chinawa JM, Chinawa AT, Ossai EN, Chukwu BF, Ndu IK, Asinobi IN. Left ventricular function and cardiac valvar annular dimensions among children with sickle cell anemia compared to those with hemoglobin AA type in Enugu, Nigeria. Malawi Med J. 2021 Jun;33(2):127-134. doi: 10.4314/mmj.v33i2.8
14. Kimmo Porthan, Tuomas Kenttä, Teemu J. Niiranen, Markku S. Nieminen, Lasse Oikarinen et al. left ventricular hypertrophy as a risk predictor of sudden cardiac death. International Journal of Cardiology 2019; 276: 125-129,
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16. Lavie CJ, Milani RV, Messerli FH. Prevention and reduction of left ventricular hypertrophy in the elderly. Clin Geriatr Med. 1996;12(1):57-68.
17. Movahed MR, Martinez A, Greaves J, Greaves S, Morrell H, Hashemzadeh M. Left ventricular hypertrophy is associated with obesity, male gender, and symptoms in healthy adolescents. Obesity (Silver Spring). 2009 Mar;17(3):606-10. doi: 10.1038/oby.2008.563.
18. Chinali M, de Simone G, Roman MJ, Lee ET, Best LG, Howard BV, Devereux RB. Impact of obesity on cardiac geometry and function in a population of adolescents: the Strong Heart Study. J Am Coll Cardiol. 2006 Jun 6;47(11) :2267-73. doi: 10.1016/j.jacc.2006.03.004.
19. Woodiwiss AJ, Libhaber CD, Majane OH, Libhaber E, Maseko M. Obesity Promotes Left Ventricular Concentric Rather Than Eccentric Geometric Remodeling and Hypertrophy Independent of Blood Pressure. American Journal of Hypertension 2008; 21: 1144-1151
20. Falkner B, DeLoach S, Keith SW, Gidding SS . High risk blood pressure and obesity increase the risk for left ventricular hypertrophy in African-American adolescents. J Pediatr 2013; 162: 94-100.
21. Ching S, Chia Y, Wan Azman W. Prevalence and determinants of left ventricular hypertrophy in hypertensive patients at a primary care clinic. Malays Fam Physician. 2012;7(2-3):2-9. PMID: 25606250
22. Cuspidi C, Meani S, Sala C, Valerio C, Negri F, Mancia G. Age related prevalence of severe left ventricular hypertrophy in essential hypertension: echocardiographic findings from the ETODH study. Blood Press. 2012 ;21(3):139-45.
23. Malcolm DD, Burns TL, Mahoney LT, Lauer RM. Factors affecting left ventricular mass in childhood: The
Muscatine Study. Pediatrics. 1993;92:703–9.
24. Chirinos JA, Segers P, De Buyzere ML, Kronmal RA, Raja MW, De Bacquer D et al. Left ventricular mass: allometric scaling, normative values, effect of obesity, and prognostic performance. Hypertension. 2010 ;56(1):91-8.
25. Borzych D, Bakkaloglu SA, Zaritsky J, Suarez A, Wong W, Ranchin B, et al. International Pediatric Peritoneal Dialysis Network. Defining left ventricular hypertrophy in children on peritoneal dialysis. Clin J Am Soc Nephrol. 2011 ; 6(8):1934-43
26. Foster BJ, Mackie AS, Mitsnefes M, Ali H, Mamber S, Colan SD: A novel method of expressing left ventricular mass relative to body size in children. Circulation 117: 2769–2775, 27.
27. Agabiti-Rosei E, Muiesan ML. Left ventricular hypertrophy and heart failure in women. J Hypertens Suppl. 2002 May;20(2):34-8.
28. va Gerdts, Raffaele Izzo, Costantino Mancusi, Maria Angela Losi, Maria Virginia Manzi, Grazia Canciello, et al. Left ventricular hypertrophy offsets the sex difference in cardiovascular risk (the Campania Salute Network), International Journal of Cardiology 2018; 258: 257-261,
29. Goble MM, Mosteller M, Moskowitz WB, Schieken RM. Sex differences in the determinants of left ventricular mass in childhood. The Medical College of Virginia Twin Study. Circulation. 1992 ;85(5):1661-5.
30. Dai S, Harrist RB, Rosenthal GL, Labarthe DR. Effects of body size and body fatness on left ventricular mass in children and Adolescents Project Heartbeat. Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine. Am J Prev Med. 2009;37:97–104.
31. Stephen R. Daniels, Richard A. Meyer, Yichang Liang, and Kevin E. Echocardiographically Determined Left Ventricular Mass Index in Normal Children, Adolescents and Young Adults. J Am Coll Cardiol. 1998 ; 12 (3) 703–708
32. Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I et al. Echocardiographic assessment of left ventricular hypertrophy: Comparison to necropsy findings. Am J Cardiol 1986; 57: 450–458
33. Brady TM, Fivush B, Flynn JT, Parekh R. Ability of blood pressure to predict left ventricular hypertrophy in children with primary hypertension. J Pediatr. 2008;152:73–8. 8
34. Pruette CS, Fivush BA, Flynn JT, Brady TM. Effects of obesity and race on left ventricular geometry in hypertensive children. Pediatr Nephrol. 2013;28:2015–22.
35. Urbina EM, Gidding SS, Bao W, Pickoff AS, Berdusis K, Berenson GS. Effect of body size, ponderosity, and blood pressure on left ventricular growth in children and young adults in the Bogalusa Heart Study. Circulation. 1995;91:2400–6.35.
36. Lauer MS, Anderson KM, Kannel WB, Levy D. The impact of obesity on left ventricular mass and geometry. The Framingham Heart Study. JAMA. 1991;266:231–6.
37. Abel ED, Litwin SE, Sweeney G. Cardiac remodeling in obesity. Physiol Rev. 2008;88:389–419. .
38. Bastien M, Poirier P, Lemieux I, Despres JP. Overview of epidemiology and contribution of obesity to cardiovascular disease. Prog Cardiovasc Dis. 2014;56:369–81.
39. Ouchi N, Parker JL, Lugus JJ, Walsh K. Adipokines in inflammation and metabolic disease. Nat Rev Immunol. 2011;11:85–97.
40. Brady TM. The Role of Obesity in the Development of Left Ventricular Hypertrophy Among Children and Adolescents. Curr Hypertens Rep. 2016 ;18(1):3.
41. Dusan P, Tamara I, Goran V, Gordana ML, Amira PA. Left ventricular mass and diastolic function in obese children and adolescents. Pediatr Nephrol. 2015;30:645–52.
42. Dewey FE, Rosenthal D, Murphy DJ, Jr, Froelicher VF, Ashley EA. Does size matter? Clinical applications of scaling cardiac size and function for body size. Circulation. 2008;117:2279–2287.
43. Jari AL, Hassan K, Sudhir K, Peter W, Jouni K, Kimmo R et al. Left Ventricular Mass and the Risk of Sudden Cardiac Death: A Population‐Based Study Journal of the American Heart Association. 2014;3:e001285
44. Reinier K, Dervan C, Singh T, Uy‐Evanado A, Lai S, Gunson K, et al. Increased left ventricular mass and decreased left ventricular systolic function have independent pathways to ventricular arrhythmogenesis in coronary artery disease. Heart Rhythm. 2011; 8:1177–1182.
45. Karakan S, Inan B. The relationship between left ventricular mass index and body composition in new-diagnosed hypertensive patients. Clin Hypertens. 2015;21:23. doi: 10.1186/s40885-015-0033-6.
46. Liao Y, Cooper RS, Durazo-Arzivu R, Mensah GA, Ghali JK. Prediction of mortality risk by different methods of indexation for left ventricular mass. J Am Coll Cardiol. 1997;26:641–647. doi: 10.1016/S0735-1097(96)00552-9.
47. Bethany J. Foster, Tao Gao, Andrew SM, Babette SZ, Huma A et al. Limitations of Expressing Left Ventricular Mass Relative to Height and to Body Surface Area in Children. Journal of the American Society of Echocardiography Volume 26 Number 4
48. Piraye K, Mehmet K, Tuncer MC, Hatipoglu ES. Left Ventricular Mass in Normal Children and its Correlation with Weight, Height and Body Surface Area. Int. J. Morphol 2011; 29(3):982-987, 2011.
49. Padovani CR, Manfrin TC, Gobbi M, Martino RS, Bregagnollo EA. Percentile curves of normal values of echocardiographic measurements in normal children from the Central-Southern region of the state of São Paulo, Brazil. Arq. Bras. Cardiol 2006; 87(6):711-21
50. Dai S, Harrist RB, Rosenthal GL, Labarthe DR. Effects of body size and body fatness on left ventricular mass in children and adolescents. Am. J. Prev. Med 2009, 37(1 Suppl): 97-104, 2009.
2. Chinawa AT, Chinawa JM. Compendium of cardiac diseases among children presenting in tertiary institutions in southern Nigeria: a rising trend. Libyan J Med. 2021 ;16(1):1966217. doi: 10.1080/19932820.2021.1966217.
3. Ujunwa FA, Ujuanbi IS1, Chinawa JM. Complex Congenital Heart Diseases Among Children Presenting for Cardiac Surgery in a Tertiary Health Facility in Enugu; South-East Nigeria. A rising trend. Nigerian Journal of Clinical Practice 24(1): 100-103,|DOI: 10.4103/njcp.njcp_134_20
4. Fox E, Taylor H, Andrew M, Han H, Mohamed E, Garrison R, et al. Body mass index and blood pressure influences on left ventricular mass and geometry in African Americans: The Atherosclerotic Risk in Communities (ARIC) Study. Hypertension. 2004 ;44(1):55-60. doi: 10.1161/01.HYP.0000132373.26489.58.
5. de Simone G, Verdecchia P, Pede S, Gorini M, Maggioni AP. Prognosis of inappropriate left ventricular mass in hypertension: the MAVI Study. Hypertension. 2002 ;40(4):470-6.
6. Amin RS, Kimball TR, Bean JA, Jeffries JL, Willging JP, Cotton RT, Witt SA, Glascock BJ, Daniels SR. Left ventricular hypertrophy and abnormal ventricular geometry in children and adolescents with obstructive sleep apnea. Am J Respir Crit Care Med. 2002; 15;165(10):1395-9. doi: 10.1164/rccm.2105118.
7. Metwalley KA, Farghaly HS, Abdelhamid A. Left ventricular functions in children with newly diagnosed Graves' disease. A single-center study from Upper Egypt. Eur J Pediatr. 2018 ;177(1):101-106. doi: 10.1007/s00431-017-3039-0.
8. Ngabea MA, Ojji DB, Umar H, Isezuo SA. Prevalence of echocardiographic left ventricular hypertrophy among hypertensives in a tertiary health institution in Nigeria. Ann Med Res Pract 2022;3:3.
9. Marketou ME, Parthenakis F, Vardas PE. Pathological Left Ventricular Hypertrophy and Stem Cells: Current Evidence and New Perspectives. Stem Cells Int. 2016;2016:5720758. doi: 10.1155/2016/5720758
10. Duru CO, Chinawa JM, Chukwu BF. “Echocardiographic Assessment of Ventricular Function in Children With Human Immunodeficiency Virus on Highly Active Antiretroviral Therapy”. Cardiology and Angiology 2021;10 (1):11-
22. https://doi.org/10.9734/ca/2021/v10i130154.
11. Ige, Olukemi O.; Oguche, Stephen; Yilgwan, Christopher S.; Bode-Thomas, Fidelia. Left ventricular mass and diastolic dysfunction in children infected with the human immunodeficiency virus. Nigerian Journal of Cardiology 2014; 11(1): 8-12 DOI: 10.4103/0189-7969.130044
12. Chinawa A, Chinawa JM, Chukwu BF, Ossai N, Ndu IK, Asinobi I, et al. The Impact of Body Mass Index on Left Ventricular Mass Index, Right Ventricular Function, and Cardiac Dimension of Children with Sickle Cell Anemia in Enugu City. Nigerian Journal of Clinical Practice 2021; 24(7): 1044-1051. DOI: 10.4103/njcp.njcp_481_20
13. Chinawa JM, Chinawa AT, Ossai EN, Chukwu BF, Ndu IK, Asinobi IN. Left ventricular function and cardiac valvar annular dimensions among children with sickle cell anemia compared to those with hemoglobin AA type in Enugu, Nigeria. Malawi Med J. 2021 Jun;33(2):127-134. doi: 10.4314/mmj.v33i2.8
14. Kimmo Porthan, Tuomas Kenttä, Teemu J. Niiranen, Markku S. Nieminen, Lasse Oikarinen et al. left ventricular hypertrophy as a risk predictor of sudden cardiac death. International Journal of Cardiology 2019; 276: 125-129,
15. Borzych D, Bakkaloglu SA, Zaritsky J, Suarez A, Wong W, Ranchin B, et al. International Pediatric Peritoneal Dialysis Network. Defining left ventricular hypertrophy in children on peritoneal dialysis. Clin J Am Soc Nephrol. 2011 ;6(8):1934-43.
16. Lavie CJ, Milani RV, Messerli FH. Prevention and reduction of left ventricular hypertrophy in the elderly. Clin Geriatr Med. 1996;12(1):57-68.
17. Movahed MR, Martinez A, Greaves J, Greaves S, Morrell H, Hashemzadeh M. Left ventricular hypertrophy is associated with obesity, male gender, and symptoms in healthy adolescents. Obesity (Silver Spring). 2009 Mar;17(3):606-10. doi: 10.1038/oby.2008.563.
18. Chinali M, de Simone G, Roman MJ, Lee ET, Best LG, Howard BV, Devereux RB. Impact of obesity on cardiac geometry and function in a population of adolescents: the Strong Heart Study. J Am Coll Cardiol. 2006 Jun 6;47(11) :2267-73. doi: 10.1016/j.jacc.2006.03.004.
19. Woodiwiss AJ, Libhaber CD, Majane OH, Libhaber E, Maseko M. Obesity Promotes Left Ventricular Concentric Rather Than Eccentric Geometric Remodeling and Hypertrophy Independent of Blood Pressure. American Journal of Hypertension 2008; 21: 1144-1151
20. Falkner B, DeLoach S, Keith SW, Gidding SS . High risk blood pressure and obesity increase the risk for left ventricular hypertrophy in African-American adolescents. J Pediatr 2013; 162: 94-100.
21. Ching S, Chia Y, Wan Azman W. Prevalence and determinants of left ventricular hypertrophy in hypertensive patients at a primary care clinic. Malays Fam Physician. 2012;7(2-3):2-9. PMID: 25606250
22. Cuspidi C, Meani S, Sala C, Valerio C, Negri F, Mancia G. Age related prevalence of severe left ventricular hypertrophy in essential hypertension: echocardiographic findings from the ETODH study. Blood Press. 2012 ;21(3):139-45.
23. Malcolm DD, Burns TL, Mahoney LT, Lauer RM. Factors affecting left ventricular mass in childhood: The
Muscatine Study. Pediatrics. 1993;92:703–9.
24. Chirinos JA, Segers P, De Buyzere ML, Kronmal RA, Raja MW, De Bacquer D et al. Left ventricular mass: allometric scaling, normative values, effect of obesity, and prognostic performance. Hypertension. 2010 ;56(1):91-8.
25. Borzych D, Bakkaloglu SA, Zaritsky J, Suarez A, Wong W, Ranchin B, et al. International Pediatric Peritoneal Dialysis Network. Defining left ventricular hypertrophy in children on peritoneal dialysis. Clin J Am Soc Nephrol. 2011 ; 6(8):1934-43
26. Foster BJ, Mackie AS, Mitsnefes M, Ali H, Mamber S, Colan SD: A novel method of expressing left ventricular mass relative to body size in children. Circulation 117: 2769–2775, 27.
27. Agabiti-Rosei E, Muiesan ML. Left ventricular hypertrophy and heart failure in women. J Hypertens Suppl. 2002 May;20(2):34-8.
28. va Gerdts, Raffaele Izzo, Costantino Mancusi, Maria Angela Losi, Maria Virginia Manzi, Grazia Canciello, et al. Left ventricular hypertrophy offsets the sex difference in cardiovascular risk (the Campania Salute Network), International Journal of Cardiology 2018; 258: 257-261,
29. Goble MM, Mosteller M, Moskowitz WB, Schieken RM. Sex differences in the determinants of left ventricular mass in childhood. The Medical College of Virginia Twin Study. Circulation. 1992 ;85(5):1661-5.
30. Dai S, Harrist RB, Rosenthal GL, Labarthe DR. Effects of body size and body fatness on left ventricular mass in children and Adolescents Project Heartbeat. Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine. Am J Prev Med. 2009;37:97–104.
31. Stephen R. Daniels, Richard A. Meyer, Yichang Liang, and Kevin E. Echocardiographically Determined Left Ventricular Mass Index in Normal Children, Adolescents and Young Adults. J Am Coll Cardiol. 1998 ; 12 (3) 703–708
32. Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I et al. Echocardiographic assessment of left ventricular hypertrophy: Comparison to necropsy findings. Am J Cardiol 1986; 57: 450–458
33. Brady TM, Fivush B, Flynn JT, Parekh R. Ability of blood pressure to predict left ventricular hypertrophy in children with primary hypertension. J Pediatr. 2008;152:73–8. 8
34. Pruette CS, Fivush BA, Flynn JT, Brady TM. Effects of obesity and race on left ventricular geometry in hypertensive children. Pediatr Nephrol. 2013;28:2015–22.
35. Urbina EM, Gidding SS, Bao W, Pickoff AS, Berdusis K, Berenson GS. Effect of body size, ponderosity, and blood pressure on left ventricular growth in children and young adults in the Bogalusa Heart Study. Circulation. 1995;91:2400–6.35.
36. Lauer MS, Anderson KM, Kannel WB, Levy D. The impact of obesity on left ventricular mass and geometry. The Framingham Heart Study. JAMA. 1991;266:231–6.
37. Abel ED, Litwin SE, Sweeney G. Cardiac remodeling in obesity. Physiol Rev. 2008;88:389–419. .
38. Bastien M, Poirier P, Lemieux I, Despres JP. Overview of epidemiology and contribution of obesity to cardiovascular disease. Prog Cardiovasc Dis. 2014;56:369–81.
39. Ouchi N, Parker JL, Lugus JJ, Walsh K. Adipokines in inflammation and metabolic disease. Nat Rev Immunol. 2011;11:85–97.
40. Brady TM. The Role of Obesity in the Development of Left Ventricular Hypertrophy Among Children and Adolescents. Curr Hypertens Rep. 2016 ;18(1):3.
41. Dusan P, Tamara I, Goran V, Gordana ML, Amira PA. Left ventricular mass and diastolic function in obese children and adolescents. Pediatr Nephrol. 2015;30:645–52.
42. Dewey FE, Rosenthal D, Murphy DJ, Jr, Froelicher VF, Ashley EA. Does size matter? Clinical applications of scaling cardiac size and function for body size. Circulation. 2008;117:2279–2287.
43. Jari AL, Hassan K, Sudhir K, Peter W, Jouni K, Kimmo R et al. Left Ventricular Mass and the Risk of Sudden Cardiac Death: A Population‐Based Study Journal of the American Heart Association. 2014;3:e001285
44. Reinier K, Dervan C, Singh T, Uy‐Evanado A, Lai S, Gunson K, et al. Increased left ventricular mass and decreased left ventricular systolic function have independent pathways to ventricular arrhythmogenesis in coronary artery disease. Heart Rhythm. 2011; 8:1177–1182.
45. Karakan S, Inan B. The relationship between left ventricular mass index and body composition in new-diagnosed hypertensive patients. Clin Hypertens. 2015;21:23. doi: 10.1186/s40885-015-0033-6.
46. Liao Y, Cooper RS, Durazo-Arzivu R, Mensah GA, Ghali JK. Prediction of mortality risk by different methods of indexation for left ventricular mass. J Am Coll Cardiol. 1997;26:641–647. doi: 10.1016/S0735-1097(96)00552-9.
47. Bethany J. Foster, Tao Gao, Andrew SM, Babette SZ, Huma A et al. Limitations of Expressing Left Ventricular Mass Relative to Height and to Body Surface Area in Children. Journal of the American Society of Echocardiography Volume 26 Number 4
48. Piraye K, Mehmet K, Tuncer MC, Hatipoglu ES. Left Ventricular Mass in Normal Children and its Correlation with Weight, Height and Body Surface Area. Int. J. Morphol 2011; 29(3):982-987, 2011.
49. Padovani CR, Manfrin TC, Gobbi M, Martino RS, Bregagnollo EA. Percentile curves of normal values of echocardiographic measurements in normal children from the Central-Southern region of the state of São Paulo, Brazil. Arq. Bras. Cardiol 2006; 87(6):711-21
50. Dai S, Harrist RB, Rosenthal GL, Labarthe DR. Effects of body size and body fatness on left ventricular mass in children and adolescents. Am. J. Prev. Med 2009, 37(1 Suppl): 97-104, 2009.
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Jun 16, 2025
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Chinawa, J., Ossai , E., & Chinawa , A. (2025). Determinants of Left Ventricular Mass Among Apparently Normal Children in Enugu State. Nigerian Medical Journal, 66(2), 669–680. https://doi.org/10.71480/nmj.v66i2.779
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