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Subclinic cardiac involvement in paediatric patients with celiac disease: a novel sign for a case finding approach
E Lionetti1, C Catassi, R Francavilla
1Department of Pediatrics, University of Catania, Via Santa Sofia, 78095124- Bari, Italy. elenalionetti@inwind.it
Insights
Children with celiac disease (CD) often show early heart issues, like valve problems. A gluten-free diet (GFD) significantly improved cardiac function and resolved valve issues in these young patients.
Area of Science:
- Pediatric Cardiology
- Gastroenterology
- Clinical Medicine
Background:
- Celiac disease (CD) is an autoimmune disorder triggered by gluten ingestion.
- Early cardiac involvement in pediatric CD is not well-characterized.
- Assessing cardiac function in children with CD is crucial for comprehensive management.
Purpose of the Study:
- To determine the prevalence of early cardiac abnormalities in children diagnosed with celiac disease.
- To investigate the effect of a gluten-free diet (GFD) on cardiac parameters in pediatric CD patients.
- To evaluate echocardiographic changes following a GFD intervention.
Main Methods:
- Echocardiographic examinations were performed on 60 children with CD and 45 healthy controls.
- Key echocardiographic parameters included ejection fraction (EF), fractional shortening (FS), and left ventricular dimensions (LVDD, LVSD).
- Valve regurgitation was assessed, and CD patients were re-evaluated after one year on a GFD.
Main Results:
- Mild cardiac involvement, including valve regurgitation and impaired ejection fraction, was significantly more common in CD children (21.7%) than controls (2.2%).
- CD patients exhibited lower contractility indices and increased left ventricular dimensions compared to controls.
- Following a one-year GFD, all cases of valve regurgitation resolved, and echocardiographic parameters showed significant improvement.
Conclusions:
- Subclinical cardiac involvement is frequent in children with celiac disease.
- A gluten-free diet can lead to significant improvements in cardiac function and resolution of valve lesions in pediatric CD.
- Early detection and dietary management are important for addressing cardiac manifestations in celiac disease.
Abstract:
The aim of the present work was to assess the prevalence of early cardiac involvement in children with celiac disease (CD), and the impact of a gluten free diet (GFD) on this issue. Sixty CD children was compared with a control group of 45 healthy children by an echocardiographic examination. CD patients were re-evaluated 1-year after 1-year GFD. Main outcome measures were ejection fraction (EF), fractional shortening (FS), left ventricular end-diastolic diameter (LVDD), left ventricular end-systolic diameter (LVSD), any regurgitating valve lesions. Mild cardiac involvement was found in 13 CD children and in one control (21.7% vs. 2.2%; p=0.003), and was secondary to regurgitation of mitral valve, aortic valve, pulmonary and tricuspid valve, or to impaired ejection fraction. CD children as compared to controls had significantly lower contractility indices, and higher left ventricular dimensions. In patients adhering to the GFD all valve regurgitations resolved, and the echocardiographic parameters significantly improved. Subclinical cardiac involvement in CD children is quite frequent, and GFD may exert a beneficial effect on the overall cardiac performance.
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