Arterial distensibility in children and teenagers: normal evolution and the effect of childhood vasculitis

• Published in: Archives of disease in childhood Vol. 87; no. 4; pp. 348 - 351
• Main Authors: Cheung, Y F, Brogan, P A, Pilla, C B, Dillon, M J, Redington, A N
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health 01-10-2002; BMJ; BMJ Publishing Group Ltd; BMJ Publishing Group LTD
• Subjects: Adolescent; Adolescents; Age; Aging - physiology; Analysis of Variance; arteries; Arteries - physiology; Arteries - physiopathology; Atherosclerosis; Biological and medical sciences; Blood Flow Velocity; Blood pressure; Body Composition; Body mass index; Body weight; Child; Child, Preschool; Children; Children & youth; Confidence intervals; Control Groups; distensibility; Elasticity; Female; Humans; Hypertension; Inflammation; Kidney diseases; Linear Models; Male; Medical sciences; Mortality; Multivariate analysis; Original; Periarteritis nodosa; Photoplethysmography - methods; Physiological aspects; Polyarteritis nodosa; Polyarteritis Nodosa - physiopathology; Pulsatile Flow; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Software; Variables; Vascular Resistance; Vasculitis; Veins & arteries; Velocity; Wave velocity; Human; Necrotizing vasculitis; Mechanical properties; Cardiovascular disease; Arterial pulse; Velocity; Artery; Preadolescent; Arteritis; Arterial disease; Vascular disease; Wave; Adolescent; Child
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/adc.87.4.348

Background: Polyarteritis nodosa is a necrotising vasculitis of the medium sized and small muscular arteries. The inflammatory and subsequent reparative processes may alter the arterial mechanical properties. The effect of vasculitic damage on arterial distensibility has never been explored however. Aim: To determine the normal values and the effect of childhood vasculitis on arterial distensibility in children and teenagers. Methods: Distensibility of the brachioradial arterial segment was studied using pulse wave velocity (PWV ∝1/√distensibility), in 13 children with polyarteritis nodosa at a median age of 11.8 (range 4.9–16) years. As a control group, 155 healthy schoolchildren (6–18 years, 81 boys) were studied. PWV was assessed using a photoplethysmographic technique; blood pressure was measured by an automatic sphygmomanometer (Dinamap). Data from patients were expressed as z scores adjusted for age and compared to a population mean of 0 by a single sample t test. Determinants of PWV in normal children were assessed by univariate and multivariate linear regression analyses. Results: Age, height, weight, and systolic blood pressure correlated individually with the brachioradial PWV. Multivariate analysis identified age as the only independent determinant. Ten of the patients were in clinical remission, while three had evidence of disease activity at the time of study. The PWV in the patient group as a whole was significantly greater than those in healthy children (mean z score +0.99). Raised C reactive protein concentration (>2 mg/dl) in the three patients with active disease was associated with a higher PWV when compared to those in remission (z score +2.78 v +0.45). The diastolic blood pressure of the patients was higher than those of the controls (z score +1.04) while the systolic pressure was similar (z score −0.36). Conclusions: PWV in the brachioradial arterial segment increases gradually during childhood independent of body weight, height, mass, and blood pressure. Increased PWV, and hence decreased distensibility, in this peripheral arterial segment occurs in polyarteritis nodosa and is amplified during acute inflammatory exacerbation.