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(Circulation. 1995;92:3156-3157.)
© 1995 American Heart Association, Inc.

Articles

Large Hearts in Children

Biology or Disease?

Richard M. Schieken, MD

From the Division of Pediatric Cardiology, Children's Medical Center, Medical College of Virginia/Virginia Commonwealth University, Richmond.

Correspondence to Richard M. Schieken, MD, Children's Medical Center, PO Box 980026, Richmond, VA 23298-0026. E-mail schieken@gems.vcu.edu.

	Introduction

 
Daniels et al,¹ in this issue of Circulation, used the technique of dual-energy x-ray absorptiometry to determine lean body mass and asked two questions: What determines echocardiographic left ventricular (LV) mass in children, and is LV mass a modifiable risk factor for coronary heart disease? There are important reasons to consider that LV hypertrophy in children may be a coronary heart disease risk factor. LV hypertrophy, as detected by the ECG in hypertensive adults studied in the Framingham Heart Study, is recognized to be a serious risk factor for the development of coronary heart disease.² In subsequent studies, investigators from that study discovered that the identification of LV hypertrophy by echocardiographic rather than by ECG measures is an even more powerful predictor of coronary heart disease than hypertension.^{3 4} Therefore, the appearance of echocardiographic LV hypertrophy in adults is an important finding that may presage a disease state.

After the identification of risk factors for the development of coronary heart disease in adults, investigators described the distribution of these risk variables in the pediatric population.^{5 6} They asked whether the level of these variables would predict the risk for subsequent development of coronary heart disease when these children became adults.⁷ Tracking, or the persistence of peer rank order over time, was one principal strategy used to detect risk.⁸ Those individuals who persistently tracked in the upper part of the distribution for a variable considered to be a risk factor were thought to be at higher risk as adults.

Because excess LV mass . . . [Full Text of this Article]

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