Myocardial performance in children with autoimmune hepatitis: Doppler tissue imaging study

Abstract

Purpose The aim of this study was to assess subclinical impact of autoimmune hepatitis (AIH) on global myocardial performance in children using Doppler tissue imaging (DTI) and to correlate it with total serum IgG. Methods We included 30 children with AIH (mean age = 12.67 ± 2.9 years) as the study group and 20 age and sex matched healthy children (mean age = 11.93 ± 2.66 years) as the control group. Conventional two-dimensional echocardiography was performed to both groups and DTI were used to determine Right ventricular (RV) and left ventricular (LV) Tei indexes. Total serum IgG levels at initial diagnosis of AIH were retrieved from our hospital data-base and were correlated to the cardiac functions of AIH patients. Results Right ventricular (RV) and left ventricular (LV) Tei indexes were significantly higher in AIH group (mean ± SD: 0.46 ± 0.088 vs. 0.26 ± 0.01, P 0.0001 and 0.45 ± 0.086 vs. 0.31 ± 0.02, P 0.0001 , respectively). Mitral and tricuspid systolic (Sm) velocities were significantly lower in AIH children (mean ± SD: 8.226 ± 1.73 vs. 9.93 ± 0.94 cm/s, P = 0.0002 and 10.85 ± 1.11 vs. 12.48 ± 0.53 cm/s, P 0.0001 , respectively). Total IgG concentrations were significantly higher in AIH children [mean ± SD: 2841.3 ± 607.17 vs. 862.67 ± 70.35 mg/dl, P 0.0001 ], and they correlated positively with the LV Tei index ( r = 0.69, P 0.0001 ) and the RV Tei index ( r = 0.61, P 0.0003 ) and correlated negatively with the mitral systolic (Sm) velocity ( r = −0.76, P 0.0001 ) and tricuspid systolic (Sm) velocity ( r = −0.66, P 0.0001 ), on the other hand, fractional shortening (FS) did not correlate with serum IgG concentrations ( r = - 0.04 , P = 0.821 ). Conclusion The DTI technique appears to be more sensitive than conventional echocardiography in the early detection of myocardial dysfunction in AIH children.