Abstract
Inflammatory bowel disease (IBD) is an established risk factor for cardiovascular disease (CVD). However, whether cardiac consequences present early in IBD is unknown. This is the first study in children aiming to unmask altered myocardial mechanics in IBD. We enrolled 50 consecutive normotensive children with Crohn’s disease (CD) (n = 28) or ulcerative colitis (UC) (n = 22). The study groups consisted of 18 patients with active inflammatory disease (mean age 14.6 ± 2.5 years) and 32 children with IBD in remission (14.3 ± 2.3 years). 60 age- and gender-matched children served as healthy controls. Speckle tracking stress echocardiography (STE) was used to assess left ventricular (LV) myocardial strain and strain rate. Circumferential strain rate was significantly decreased in children with active IBD (−1.55 ± 0.26 s−1) and IBD in remission (−1.49 ± 0.26 s−1) versus healthy controls (1.8 ± 0.4 s−1) both at rest (p < 0.001) and during exercise (p = 0.021). Moreover, longitudinal strain rate, circumferential strain and E/E′ ratio were significantly impaired in IBD. Pediatric patients with IBD feature subclinical signs of LV systolic and diastolic myocardial impairment early in the course of CD and UC. This may not be reversible even when IBD is clinically controlled. Patients with IBD should be regularly screened for signs of CVD.
Highlights
The study group consisted of 18 consecutive patients with active IBD and 32 patients with IBD in remission who are being followed up at the Pediatric Gastroenterology Clinic at Helios University Medical Centre Wuppertal, Germany. 60 healthy age- and sex-matched volunteers served as the control group. 22 patients had been diagnosed with Crohn’s disease (CD) and 28 had ulcerative colitis (UC)
Study group patients were stratified into sub-groups of active disease and IBD in remission by two experienced pediatric gastroenterologists according to disease activity indices, endoscopy results, degree of mucosal healing, clinical course and individual well-being
Serum C-reactive protein was significantly increased in the active disease group (46.4 ± 35.6 mg/l) when compared to IBD patients in remission (21.6 ± 14.3 mg/l; p = 0.006)
Summary
Chronic inflammation has been demonstrated to be accompanied by pathological collagen disposition in affected organs[15, 16]. Affects other organs, e.g. the heart in IBD, yet remains to be illuminated Studies in both adult and pediatric patients have demonstrated an association of IBD and early signs of subclinical atherosclerosis[17, 18]. Studies in adult patients have utilized STE to demonstrate subclinical cardiac impairment in both UC24, 25 and CD25, 26. Whether myocardial function is already pathologically changed in pediatric patients with IBD is still unknown This is the first study in children aiming to utilize STE in CD, UC and healthy controls to uncover subclinical myocardial impairment in an early state of IBD
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