Dependence of P-wave dispersion on mean arterial pressure as an independent hemodynamic variable in school children
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Introduction:The relationship between diastolic dysfunction and P-wave dispersion (PWD) in the electrocardiogram has been studied for some time. In this regard, echocardiography is emerging as a diagnostic tool to improve risk stratification for mild hypertension.
Objective:To determine the dependence of PWD on the electrocardiogram and on echocardiographic variables in a pediatric population.
Methods: Five hundred and fifteen children from three elementary schools were studiedfrom a total of 565 children. Those whose parents did not want them to take part in the study, as well as those with known congenital diseases, were excluded. Tests including 12-lead surface ECGs and 4 blood pressure (BP) measurements were performed. Maximum and minimum P-values were measured, and the PWD on the electrocardiogram was calculated. Echocardiography for structural measurements and the pulsed Doppler of mitral flow were also performed.
Results: A significant correlation in statistical variables was found between PWD and mean BP for pre-hypertensive and hypertensive children, i.e., r= 0.32, p <0.01 and r= 0.33, p <0.01, respectively. There was a significant correlation found between PWD and the left atrial area (r= 0.45 and p <0.01).
Conclusions: We highlight the dependency between PWD, the electrocardiogram and mean blood pressure. We also draw attention to the dependence of PWD on the left atrial area. This result provides an explanation for earlier changes in atrial electrophysiological and hemodynamic characteristics in pediatric patients.
- P-wave dispersion
- mitral A-wave duration
- prehypertension
- blood hypertension
Diagne N, Rogier C, Cisse B, Trape JF. Incidence of clinical malaria in pregnant women exposed to intense perennial transmission. Trans R Soc Trop Med Hyg. 1997; 91(2): 166-70. DOI: https://doi.org/10.1016/S0035-9203(97)90209-1
Steketee RW, Nahlen BL, Parise ME, Menendez C. The burden of malaria in pregnancy in malaria-endemic areas. Am J Trop Med Hyg. 2001; 64: 28-35. DOI: https://doi.org/10.4269/ajtmh.2001.64.28
Rodriguez-Morales AJ, Sanchez E, Vargas M, Piccolo C, Colina R, Arria M, et al. Pregnancy outcomes associated with Plasmodium vivax malaria in northeastern Venezuela. Am J Trop Med Hyg. 2006; 74(5): 755-7. DOI: https://doi.org/10.4269/ajtmh.2006.74.755
Desai M, ter Kuile FO, Nosten F, McGready R, Asamoa K, Brabin B, et al. Epidemiology and burden of malaria in pregnancy. Lancet Infect Dis. 2007; 7(2): 93-104. DOI: https://doi.org/10.1016/S1473-3099(07)70021-X
Carmona-Fonseca J, Maestre A. Incidencia de la Malaria Gestacional, Congénita y Placentaria en Urabá (Antioquia-Colombia), 2005-2007. Rev Colomb Obstetr Ginecol. 2009; 60: 12-26. DOI: https://doi.org/10.18597/rcog.351
Lin HMT, Guilbert L, Tuntipopiat S, Wegmann TG. Synthesis of T helper 2 type cytokines at the maternal-fetal interface. J Immunol. 1993; 151: 4562-73. DOI: https://doi.org/10.4049/jimmunol.151.9.4562
Achidi EA, Apinjoh TO, Titanji VP. Malaria parasitemia and systemic cytokine bias in pregnancy. Int J Gynaecol Obstet. 2007; 97(1): 15-20. DOI: https://doi.org/10.1016/j.ijgo.2006.12.015
Fried M, Nosten F, Brockman A, Brabin BJ, Duffy PE. Maternal antibodies block malaria. Nature. 1998; 395(6705): 851-2. DOI: https://doi.org/10.1038/27570
Rogerson SJ, Hviid L, Duffy PE, Leke RF, Taylor DW. Malaria in pregnancy: pathogenesis and immunity. Lancet Infect Dis. 2007; 7(2): 105-17. DOI: https://doi.org/10.1016/S1473-3099(07)70022-1
Abrams ET, Brown H, Chensue SW, Turner GD, Tadesse E, Lema VM, et al. Host response to malaria during pregnancy: placental monocyte recruitment is associated with elevated beta chemokine expression. J Immunol. 2003; 170(5): 2759-64. DOI: https://doi.org/10.4049/jimmunol.170.5.2759
Ordi J, Menendez C, Ismail MR, Ventura PJ, Palacín A, Kahigwa E, et al. Placental malaria is associated with cell-mediated inflammatory responses with selective absence of natural killer cells. J Infect Dis. 2001; 183(7): 1100-7. DOI: https://doi.org/10.1086/319295
Enato EF, Mens PF, Okhamafe AO, Okpere EE, Pogoson E, Schallig HD. Plasmodium falciparum malaria in pregnancy: prevalence of peripheral parasitaemia, anaemia and malaria care-seeking behaviour among pregnant women attending two antenatal clinics in Edo State, Nigeria. J Obstet Gynaecol. 2009; 29(4): 301-6. DOI: https://doi.org/10.1080/01443610902883320
Carmona FJ. La malaria en Colombia, Antioquia y las zonas de Urabá y Bajo Cauca: panorama para interpretar la falla terapéutica antimalárica. Parte 2. Iatreia. 2004; 17: 34-53.
Carmona-Fonseca J, Arango FE. Malaria mixta: prevalencia en Colombia y América Latina. Iatreia. 2012; 25: 334-46. DOI: https://doi.org/10.17533/udea.iatreia.13130
Lopez-Antuñano FJ, Schmunis G. Diagnóstico microscopico de los parásitos de la malaria en sangre. OPS-OMS 1988; Publicación Científica No 512. pp 39-50.
Campos IUM, Cuesta C, Franco-Gallego A, Carmona-Fonseca J, Maestre A. Diagnosis of gestational, congenital, and placental malaria in Colombia: comparison of the efficacy of microscopy, nested polymerase chain reaction, and histopathology. Am J Trop Med Hyg. 2011; 84(6): 929-35. DOI: https://doi.org/10.4269/ajtmh.2011.10-0507
McGready R, Davison BB, Stepniewska K, Cho T, Shee H, Brockman A, et al. The effects of Plasmodium falciparum and P. vivax infections on placental histopathology in an area of low malaria transmission. Am J Trop Med Hyg. 2004; 70: 398-407. DOI: https://doi.org/10.4269/ajtmh.2004.70.398
Rogerson SJ, Mwapasa V, Meshnick SR. Malaria in pregnancy: linking immunity and pathogenesis to prevention. Am J Trop Med Hyg. 2007;77:14-22. DOI: https://doi.org/10.4269/ajtmh.77.6.suppl.14
Hartman TK, Rogerson SJ, Fischer PR. The impact of maternal malaria on newborns. Ann Trop Paediatr. 2010; 30(4): 271-82. DOI: https://doi.org/10.1179/146532810X12858955921032
Rial M. CMA, Genovés J, Carreras R. Malaria y embarazo: fisiopatología y manejo. Ginecol Obstetr Clín. 2009; 3: 157-64.
Moormann AM, Sullivan AD, Rochford RA, Chensue SW, Bock PJ, Nyirenda T, et al. Malaria and pregnancy: placental cytokine expression and its relationship to intrauterine growth retardation. J Infect Dis. 1999; 180(6): 1987-93. DOI: https://doi.org/10.1086/315135
Rogerson SJ, Brown HC, Pollina E, Abrams ET, Tadesse E, Lema VM, et al. Placental tumor necrosis factor alpha but not gamma interferon is associated with placental malaria and low birth weight in Malawian women. Infect Immun. 2003; 71(1): 267-70. DOI: https://doi.org/10.1128/IAI.71.1.267-270.2003
Okoko BJ, Enwere G, Ota MO. The epidemiology and consequences of maternal malaria: a review of immunological basis. Acta Trop. 2003; 87(2): 193-205. DOI: https://doi.org/10.1016/S0001-706X(03)00097-4
Chaisavaneeyakorn S, Moore JM, Mirel L, Othoro C, Otieno J, Chaiyaroj SC, et al. Levels of macrophage inflammatory protein 1 alpha (MIP-1 alpha) and MIP-1 beta in intervillous blood plasma samples from women with placental malaria and human immunodeficiency virus infection. Clin Diagn Lab Immunol. 2003; 10(4): 631-6. DOI: https://doi.org/10.1128/CDLI.10.4.631-636.2003
Dong S, Kurtis JD, Pond-Tor S, Kabyemela E, Duffy PE, Fried M. CXC ligand 9 response to malaria during pregnancy is associated with low-birth-weight deliveries. Infect Immun. 2012; 80(9): 3034-8. DOI: https://doi.org/10.1128/IAI.00220-12
Conroy A, Serghides L, Finney C, Owino SO, Kumar S, Gowda DC, et al. C5a enhances dysregulated inflammatory and angiogenic responses to malaria in vitro: potential implications for placental malaria. PLoS One. 2009; 4(3): e4953. DOI: https://doi.org/10.1371/journal.pone.0004953
Moore JM, Chaisavaneeyakorn S, Perkins DJ, Othoro C, Otieno J, Nahlen BL, et al. Hemozoin differentially regulates proinflammatory cytokine production in human immunodeficiency virus-seropositive and -seronegative women with placental malaria. Infect Immun. 2004; 72(12): 7022-9. DOI: https://doi.org/10.1128/IAI.72.12.7022-7029.2004
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