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Subclinical cardiac involvement in Crohn's disease and ulcerative colitis: an echocardiographic case-control study
Enrico Vizzardi1, Edoardo Sciatti, Ivano Bonadei
1Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy - enrico.vizzardi@tin.it.
Insights
Inflammatory bowel disease (IBD) patients show frequent subclinical cardiac alterations, including enlarged atria and reduced left ventricular ejection fraction. These findings highlight the need for further investigation into the cardiovascular implications of IBD.
Area of Science:
- Cardiology
- Gastroenterology
- Internal Medicine
Background:
- Cardiovascular manifestations are considered rare in inflammatory bowel disease (IBD).
- Subclinical myocardial alterations may have future implications for IBD patients.
Purpose of the Study:
- To assess cardiac structure and function in IBD patients using Doppler echocardiography and tissue Doppler imaging.
- To identify subclinical myocardial alterations in patients with Crohn's disease (CD) and ulcerative colitis (UC).
Main Methods:
- Transthoracic echocardiography was performed on 27 CD patients, 43 UC patients, and 24 healthy controls.
- Patients were selected without pre-existing cardiovascular diseases or risk factors and matched for sex and age.
Main Results:
- IBD patients exhibited larger left atrial dimensions and volume, reduced left ventricular ejection fraction, and higher pulmonary artery systolic pressure compared to controls.
- Left ventricular diastolic function was altered, and atrioventricular valve regurgitation was prevalent in IBD patients.
- Specific findings included mitral valve prolapse (25.7%), mitral valve leaflets thickening (50.0%), and pericardial effusion (4.3%) in IBD patients.
Conclusions:
- Subclinical cardiac involvement is frequent in inflammatory bowel disease patients.
- Potential underlying mechanisms include a systemic increase in cytokines and profibrotic factors.
- Further research is needed to evaluate the mechanisms and long-term implications of cardiac involvement in IBD.
Background:
Cardiovascular manifestations of inflammatory bowel disease (IBD) are considered rare. The aim of the present study was to assess cardiac structure and function by means of traditional Doppler echocardiography and tissue Doppler imaging in order to better appreciate myocardial subclinical alterations and their future implications for these kind of patients.
Methods:
Twenty-seven patients affected by Crohn's disease (CD) and 43 suffering from ulcerative colitis (UC) were enrolled. They were selected without cardiovascular diseases nor risk factors. They were compared with 24 healthy subjects matched for sex and age. Everyone underwent transthoracic echocardiography.
Results:
IBD patients had larger left atrial anterior-posterior dimension (34±7 vs. 31±2 mm; P=0.001) and volume (46±7 vs. 41±6; P=0.002), reduced left ventricular (LV) ejection fraction (59±6 vs. 63±5%; P=0.006) and higher pulmonary artery systolic pressure (26±6 vs. 22±2 mmHg; P<0.001) than healthy volunteers. Moreover, LV diastolic function was slightly altered in patients in respect of controls. Atrioventricular valve regurgitation was prevalent in IBD. Finally, we found that 18 (25.7%) patients had mitral valve prolapse, 35 (50.0%) mitral valve leaflets thickening and 3 (4.3%) pericardial effusion. We did not find differences in echocardiographic parameters between CD and UC.
Conclusions:
Our study suggests that subclinical cardiac involvement is frequent among IBD patients. The underlying mechanisms require further evaluation, but might be due to a systemic increase in cytokines and profibrotic factors.
