Epicardial fat thickness in children with classic congenital adrenal hyperplasia.

OBJECTIVE: Epicardial fat thickness (EFT) is an emerging cardiometabolic risk factor and has been shown to be related to atherosclerosis. EFT has not been studied in the context of CAH. This study aimed to evaluate EFT in children with CAH and its relation to carotid intima media thickness (CA-IMT) and left ventricular functions.

METHODS: 36 children with classic CAH were compared with 36 healthy controls. All children had confirmed CAH and received steroid substitution therapy. Patients and controls underwent anthropometric evaluation, measurement of fasting lipids, glucose, insulin, homeostasis model assessment for insulin resistance (HOMA-IR), Left ventricular functions and EFT were assessed using conventional echocardiography. Duplex ultrasonography was used to measure CA-IMT.

RESULTS: Compared to controls, patients had higher EFT (p=0.001), HOMA-IR(p=0.001), CA- IMT (p=0.01), LVMI (p=0.001) and prolonged mitral deceleration time (DcT) (p=0.01).Abnormalities were marked in uncontrolled children on medical treatment. In multivariate analysis in children with classic CAH , EFT correlated positively with waist circumference (OR =1.9,95%Cl=1.07-1.14.p=001), 17-OHP; nmol/l (OR =1.6; 95% CI = 1.33-2.89, p = 0.05), testosterone , ng/dl(OR =1.7; 95% CI = 1.55-2.13, p = 0.01), LVMI (OR=1.14, 95%Cl=1.08-1.13, p=0.0001) , mitral DcT (OR=2.25;95% CI=1.15-2.05, p=0.01) and CA-IMT (OR=1.6 ;95% CI=1.15-2.05, p=0.01).

CONCLUSIONS: EFT may be elevated in children with classic CAH particularly those with poor control and is correlated to carotid intima media thickness, left ventricular mass and mitral deceleration time. Measurement of EFT by Echocardiography in CAH children may help to identify those at high risk of developing left ventricular dysfunction and subclinical atherosclerosis.