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Evaluation of cardiac function by tissue Doppler imaging in children with chronic hepatitis
Tugcin Bora Polat1, Nafiye Urganci, Yalim Yalcin
1Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Hospital, Istanbul, Turkey.
Insights
Children with severe chronic hepatitis show subclinical right ventricular diastolic dysfunction. Tissue Doppler echocardiography can detect this early cardiac dysfunction in pediatric chronic hepatitis patients.
Area of Science:
- Cardiology
- Hepatology
- Pediatrics
Background:
- Cirrhosis leads to cirrhotic cardiomyopathy, characterized by diastolic dysfunction.
- Cardiac function has not been extensively studied in pediatric patients with chronic hepatitis.
Purpose of the Study:
- To investigate subclinical ventricular dysfunction in children with chronic hepatitis.
- To assess if cardiac dysfunction correlates with hepatic inflammation and fibrosis severity.
- To evaluate the utility of tissue Doppler echocardiography in detecting these changes.
Main Methods:
- Studied 63 children with varying degrees of chronic hepatitis (mild, moderate, severe) and 36 healthy controls.
- Classified hepatitis severity using the Knodell scoring system.
- Utilized tissue Doppler echocardiography to assess cardiac function, focusing on diastolic parameters.
Main Results:
- Severe chronic hepatitis was associated with impaired right ventricular diastolic function.
- Patients with severe hepatitis exhibited lower early diastolic velocity of the tricuspid valve annulus and longer isovolumic relaxation time compared to controls.
- A decreased ratio of peak early to late myocardial tissue velocity was observed in severe cases, indicating diastolic dysfunction.
Conclusions:
- Subclinical right ventricular dysfunction is detectable in children with prominent hepatic inflammation and fibrosis.
- Tissue Doppler echocardiography is a valuable tool for quantifying and monitoring cardiac changes in pediatric chronic hepatitis.
Objectives:
Pathoanatomic changes in cirrhosis result in impaired ventricular filling and diastolic dysfunction and were named as cirrhotic cardiomyopathy. However, cardiac functions have not been studied in patients with chronic hepatitis. We hypothesized that such patients might have subclinical ventricular dysfunction, detectable by tissue Doppler echocardiography and related to the severity of hepatic inflammation and fibrosis.
Methods:
We studied 63 clinically stable patients, 27 patients with mild chronic hepatitis (group 1), 22 patients with moderate chronic hepatitis (group 2) and 14 patients with severe chronic hepatitis (group 3) according to the scoring system of Knodell, and 36 age-matched healthy subjects.
Results:
Patients with severe chronic hepatitis had impaired right ventricular diastolic function. The early diastolic velocity of the tricuspid valve annulus was lower in patients from group 3 than in healthy subjects (P < 0.001). Patients in group 3 had a greater isovolumic relaxation time (P < 0.001), indicating right ventricular diastolic dysfunction. Comparing group 3 with the healthy subjects, the ratio of peak early myocardial tissue velocity and peak late (or atrial) myocardial tissue velocity was significantly decreased (P < 0.001), at 1.4 (0.7) and 1.9 (0.7), respectively. There was also a slightly lower peak early myocardial tissue velocity and peak late (or atrial) myocardial tissue velocity ratio and a slightly longer isovolumic relaxation time in patients from group 2 than in healthy subjects (P < 0.05).
Conclusions:
We detected subclinical dysfunction of the right ventricle in children with chronic hepatitis in whom hepatic inflammation and fibrosis is prominent. Tissue Doppler echocardiography provides a quantifiable indicator useful for detection and monitoring of disease progression.
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