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Evaluation of P-Wave Dispersion, Diastolic Function, and Atrial Electromechanical Conduction in Pediatric Patients
Ahmet Irdem1, Derya Aydın Sahin2, Mehmet Kervancioglu3
1Pediatric Cardiology Department, Okmeydani Education and Training Hospital, Istanbul, Turkey.
Insights
Pediatric subclinical hypothyroidism is linked to heart issues. This study found diastolic dysfunction, delayed atrial conduction, and altered P-wave dispersion in children with hypothyroidism.
Area of Science:
- Pediatric Cardiology
- Endocrinology
- Cardiac Electrophysiology
Background:
- Subclinical hypothyroidism (SH) is a condition defined by elevated thyroid-stimulating hormone (TSH) with normal free triiodothyronine (T3) and free thyroxine (T4).
- Pediatric SH may have subclinical cardiac manifestations that require investigation.
Purpose of the Study:
- To assess ventricular diastolic function, inter- and intraatrial conduction delays, and P-wave dispersion in pediatric patients with subclinical hypothyroidism.
- To identify early cardiac changes associated with SH in children.
Main Methods:
- The study included 30 pediatric patients diagnosed with subclinical hypothyroidism and 30 age- and sex-matched healthy controls.
- Diagnosis of SH was based on elevated TSH and normal free T3 and T4 levels.
- Conventional Doppler imaging (TDI) and electrocardiography were used to evaluate cardiac function and conduction parameters.
Main Results:
- Patients with SH exhibited impaired ventricular diastolic function, evidenced by lower E/A ratios and Em/Am ratios.
- Significantly prolonged inter- and intraatrial conduction delays were observed in the SH group.
- Abnormal P-wave dispersion was also a significant finding in pediatric patients with subclinical hypothyroidism.
Conclusions:
- Pediatric subclinical hypothyroidism is associated with significant cardiac abnormalities.
- These include ventricular diastolic dysfunction, delayed atrial electromechanical conduction, and altered P-wave dispersion.
- These findings highlight the importance of cardiac evaluation in children with SH.
Aim:
This study aimed to evaluate ventricular diastolic dysfunction, inter- and intraatrial conduction delay, and P-wave dispersion in pediatric patients with subclinical hypothyroidism.
Methods:
The study comprised a total of 30 pediatric patients with subclinical hypothyroidism (SH) (mean age 7.8 ± 3.2 years) and 30 healthy children (mean age 8.4 ± 3.6 years) as the control group. A SH diagnosis was made in the event of increased serum thyroid-stimulating hormone (TSH) and decreased serum free triiodothyronine (T3 ) and free thyroxine (T4 ) concentrations.
Results:
Conventional Doppler imaging (TDI) showed low mitral early diastolic E-wave velocity and E/A ratio (P < 0.001) and significantly higher mitral late diastolic A-wave velocity (P = 0.001) in hypothyroidism patients. Moreover, patients with hypothyroidism had significantly lower left ventricular (LV) septal Em velocity and Em /Am ratios compared with the control group (P < 0.001), whereas Am velocity was higher in hypothyroidism patients (P = 0.018). LV lateral Em velocity and Em /Am ratio were significantly lower in patients with hypothyroidism compared with the control group (P < 0.001). With regard to atrial electromechanical conduction, atrial electromechanical delay (PA) lateral, PA septum, PA tricuspid, and each of interatrial and intraatrial conduction delay were significantly prolonged in hypothyroidism patients as compared with the control group (P < 0.001, P < 0.001, P = 0.023, P = 0.002, and P = 0.003, respectively). P-wave dispersion was significantly different in the pediatric patients with hypothyroidism (P < 0.001).
Conclusion:
This study demonstrated atrial electromechanical conduction delay, abnormal P-wave dispersion, and ventricle diastolic dysfunction in pediatric patients with hypothyroidism.
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