Peer-reviewed article
A novel marker of electrical instability in children with hypertension: cardiac electrophysiological balance index.
Seyma Kayali, Emine Gulsah Ozdemir, Yucel Hanilce ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This is a clinical research study examining a cardiac biomarker (iCEB) in children with high blood pressure to detect electrical instability of the heart. The study compared 81 hypertensive children to 36 healthy controls using ECG measurements and found higher iCEB values in the hypertensive group. While the findings suggest this marker could be useful for detecting heart rhythm risks, the study is focused on a diagnostic measurement rather than child well-being outcomes or interventions.
Key points
- Children with hypertension showed significantly elevated iCEB and iCEBc values compared to healthy controls
- Most hypertensive children (64.2%) demonstrated a non-dipping blood pressure pattern
- Left ventricular hypertrophy was observed in only 8.6% of hypertensive cases
- Prolonged QTc interval was significantly more common in hypertensive children
- iCEB and iCEBc may serve as non-invasive tools for detecting subclinical electrophysiological changes
Limitations
This is a cross-sectional study examining associations only, so it cannot establish causation or predict which children will develop arrhythmias. The study does not evaluate interventions or long-term child well-being outcomes.
Abstract
BACKGROUND: Pediatric hypertension is a growing health concern, with prolonged exposure to high blood pressure potentially causing electrical instability and increasing arrhythmia risk. The index of cardiac electrophysiological balance (iCEB), calculated as QT interval divided by QRS duration, is a potential non-invasive marker for arrhythmogenesis. This study aimed to evaluate iCEB and corrected iCEB (iCEBc) in hypertensive children and investigate their relationship with arrhythmic risk. METHODS: This cross-sectional study included 81 children with primary hypertension and 36 age- and sex-matched healthy controls. Office blood pressure, 24-h ambulatory blood pressure monitoring (ABPM), standard echocardiography, and 12-lead electrocardiograms (ECGs) were obtained. QT, QTc, Tp-e, Tp-e/QT, Tp-e/QTc, iCEB, and iCEBc were calculated. Echocardiographic measurements and laboratory parameters were also evaluated. RESULTS: The mean age of the hypertensive group was 13.8 ± 3 years, with 60.5% males. Most (64.2%) demonstrated a non-dipping BP pattern. Echocardiography showed preserved ejection fraction (72.7 ± 5.4%) and shortening fraction (42 ± 5.1%), with left ventricular hypertrophy (LVH) observed in 8.6% of cases. ECG analysis revealed significantly prolonged QTc interval (416.8 ± 30.2 ms vs. 401.8 ± 23.4 ms; p = 0.008), iCEB (3.92 vs. 3.44; p = 0.02), and iCEBc (4.58 vs. 4.09; p = 0.001) values in hypertensive patients compared to controls. No significant differences were observed in Tp-e, Tp-e/QT, or Tp-e/QTc. CONCLUSION: Children with hypertension exhibit subclinical alterations in cardiac electrophysiology, including significantly elevated iCEB and iCEBc values, which may indicate electrical instability and a higher arrhythmia risk. These indices may serve as practical, non-invasive tools for early detection of subclinical electrophysiological changes in pediatric hypertension.