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Silent Signals: Analyzing Repolarization Heterogeneity and Autonomic Modulation in Children With Euthyroid
Ozlem Turan1, Tugba Burcu Ozturk Gomec1
1Pediatric Cardiology, Antalya Training and Research Hospital, University of Health Sciences, Antalya, TUR.
Insights
Children with euthyroid Hashimoto's thyroiditis (eHT) show increased heart repolarization issues and reduced heart rate variability (HRV), suggesting a higher risk for arrhythmias. Regular cardiac monitoring is recommended for these patients.
Area of Science:
- Pediatric Cardiology
- Endocrinology
- Autoimmune Diseases
Background:
- Hashimoto's thyroiditis is the most common autoimmune thyroid disease in children, often presenting in a euthyroid state.
- The cardiovascular effects of euthyroid Hashimoto's thyroiditis (eHT), particularly concerning arrhythmias and autonomic dysfunction, are not well understood in pediatric populations.
- This study investigates asymptomatic cardiovascular changes in children with eHT.
Purpose of the Study:
- To evaluate electrocardiographic markers of repolarization inhomogeneity, including P-wave dispersion (Pd), QT dispersion (QTd), and Tp-e interval.
- To assess heart rate variability (HRV) in children diagnosed with eHT.
- To identify potential predispositions to future arrhythmias in eHT patients.
Main Methods:
- A retrospective analysis comparing 67 children with eHT to 50 healthy controls.
- Evaluation included anthropometric, biochemical, electrocardiogram (ECG), echocardiographic data, and 24-hour Holter monitoring.
- Analysis focused on repolarization indices (Pd, QTd, Tp-e) and time-domain/frequency-domain HRV parameters.
Main Results:
- Children with eHT demonstrated significantly prolonged P max, Pd, QT intervals, QTd, and Tp-e intervals compared to controls (p < 0.001).
- A Pd threshold of 51 ms predicted eHT with 67% sensitivity and 72% specificity (AUC: 0.733, p = 0.001).
- Time-domain HRV was significantly reduced in eHT patients, indicating autonomic imbalance, while frequency-domain analyses showed no significant differences.
Conclusions:
- Pediatric eHT is associated with increased myocardial repolarization heterogeneity and reduced HRV, signifying a potential arrhythmia risk.
- Regular cardiac symptom assessment and ECG monitoring are crucial for managing children with eHT.
- Further research is warranted to elucidate the long-term cardiovascular implications of eHT in children.
Background:
Hashimoto's thyroiditis is the most prevalent autoimmune thyroid condition in children, typically appearing in a euthyroid state. The cardiovascular impact of euthyroid Hashimoto's thyroiditis (eHT) remains poorly understood, especially regarding its connection to arrhythmias and autonomic dysfunction. This study aimed to evaluate electrocardiographic markers of repolarization inhomogeneity (P-wave dispersion (Pd), QT dispersion (QTd), and peak-to-end interval of the T-wave (Tp-e)) as well as heart rate variability (HRV) in children with eHT to assess the asymptomatic cardiovascular effects that may predispose them to future arrhythmias.
Materials And Methods:
This retrospective analysis involved 67 patients and 50 healthy controls. Patients were evaluated for anthropometric and biochemical parameters, electrocardiogram (ECG) results, echocardiographic findings, and 24-hour Holter monitoring. ECG parameters were measured and analyzed for repolarization indices, while HRV was assessed using time-domain and frequency-domain analyses.
Results:
Patients exhibited significantly longer P max, Pd, QT intervals, QTd, and Tp-e intervals than the controls (all p < 0.001). A receiver operating characteristic analysis indicated that a Pd of 51 ms predicted the disease with 67% sensitivity and 72% specificity (area under the curve: 0.733, p = 0.001, 95% CI: 0.643-0.823). Time-domain HRV parameters (SD of all normal-to-normal intervals and SD of all the five-minute normal-to-normal intervals) were significantly lower in eHT patients, indicating an autonomic imbalance. At the same time, frequency-domain analyses revealed no significant differences.
Conclusions:
Children with eHT exhibit increased myocardial repolarization heterogeneity and reduced HRV, indicating a potential risk for arrhythmias. These findings highlight the necessity of regular cardiac symptom inquiry and ECG controls in the follow-up of these patients, considering both thyroid function and underlying autoimmune processes. Further research is needed to clarify the long-term cardiovascular risks of eHT in children.
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