Cardiac Function In Children Research Articles

Cardiac functions in children with steroid-sensitive nephrotic syndrome.

The aim of the present study was to evaluate the presence of cardiac systolic and diastolic dysfunction in pediatric patients with steroid-sensitive nephrotic syndrome (NS). The study population consisted of 19 patients with debut-relapse of NS aged 1-18years and 30 sex and age-matched healthy controls. Blood and urine samples, two M-mode conventional echocardiograms and tissue Doppler velocity imaging were evaluated in both attack and remission periods. With regard to conventional pulse wave Doppler (cPWD), steroid-sensitive NS patients (both in debut / relapse and in remission periods) had a higher peak of late diastolic flow velocities (A peak), and patients in debut / relapse had a lower E/A ratio than the control group, indicating diastolic dysfunction (overall P = 0.003 and P = 0.006, respectively). Based on tissue Doppler velocity imaging echocardiography results, patients in debut/relapse had a higher A' and a lower E'/A' ratio (overall P < 0.001 and P = 0.001, respectively). There was also a significant difference in the cPWD E/TDI E' ratio between the patients showing an increased cPWD E/TDI E' ratio in remission periods compared to in debut/relapse periods (P = 0.09). The albumin levels were positively correlated with E'/A' and E/ E' ratio (r = 0.609; P = 0.007, r = 0.472; P = 0.041 respectively). Systolic cardiac functions are preserved but diastolic functions are affected in steroid-sensitive NS patients both in debut/relapse and in remission periods in a relatively short time. The persistence of left ventricular (LV) dysfunction during the remission period requires special attention during the follow up for early detection of cardiac abnormalities.

Evaluation of cardiac function in children after percutaneous closure of atrial septal defect using speckle tracking echocardiography.

BACKGROUNDAtrial septal defect (ASD) is among the most common congenital anomalies that its neglect may cause severe right ventricular (RV)-associated cardiac dysfunction. Percutaneous closure of ASD is an efficient technique used commonly worldwide. Varieties of techniques have been used to assess postoperative changes of cardiac function. The current study has aimed to assess outcomes of percutaneous ASD closure using two-dimensional speckle tracking echocardiography (2D-STE).METHODSThis non-experimental research was conducted on 22 patients who volunteered for percutaneous ASD closure between 2016 and 2018. Cases were assessed three times including prior to percutaneous ASD closure, after 24 hours, and a month after procedure. Cases outcomes were assessed and compared during the time.RESULTSStrain rate in RV middle septal wall was significantly different (P < 0.050) between before and one month after the procedure. Comparison of indices post procedure and one month later showed better RV strain pattern but they did not have a significant difference (P > 0.050).CONCLUSIONBased on this research, STE is a quick simple method of assessing cardiac chambers and function in details. It seems that this method can replace other traditional echocardiographic methods for cardiac function tests; thus, further studies with larger groups and longer follow-up duration are strongly recommended.

Assessment of the Effects of Levothyroxine on Cardiac Functions in Children with Subclinical Hypothyroidism

Assessment of the Effects of Levothyroxine on Cardiac Functions in Children with Subclinical Hypothyroidism

P1542 Reference values for multilayer longitudinal strain in children: preliminary findings from healthy individuals

Abstract BACKGROUND Strain echocardiography is a reliable echocardiographic modality to measure myocardial mechanical deformation and evaluate regional and global myocardial systolic function, and has been demonstrated to be a useful tool for the evaluation of cardiac function in children with acquired and congenital heart diseases. Recent advancements in echocardiographic technology allow to analyze myocardial strain in multiple layers. To our knowledge, there are no published reference values for echocardiographic multilayer-specific strain measurement. AIM OF THE STUDY Aim of our study was to establish normal reference values for left ventricular (LV) and right ventricular (RV) longitudinal strain (LS) in a wide population of Italian children and to provide normal reference values of layer-specific LS in a healthy pediatric population. METHODS AND RESULT At present we have analyzed data from two-hundred (target: n = 500) healthy, consecutive subjects (age &amp;lt;18 years, mean age 7.5 ± 4yrs; range from 1 month to 17,5 years). All subjects underwent a clinical cardiological evaluation including ECG and physical examination. Subsequently, a complete echo Doppler examination including LS evaluation using speckle-tracking echocardiography was performed. Individuals were excluded if any significant abnormality was found at echocardiography (e.g. valvular regurgitation more than trivial, any structural abnormalities including small ASDs or VSDs; patients with isolated PFO were included). Subendocardial, midwall, subepicardial LS, and strain gradient (LSsubepi - LSsubendo) were also determined. LS% analysis was considered acceptable if missing data were present in no more than one segment per echocardiographic view, according to current consensus. Echocardiographic yield for LS analysis was 98.5 % for 4-chamber views, 82.5% for 2-chamber views and 84.5% for 3-chamber views. Accordingly Global Longitudinal Strain (GLS) was available overall in 82% of the population analyzed so far (n= 164 children) on all layers, with a total of 8,872 echocardiographic available segments analyzed. Normal distribution was found for global subendocardial, midwall and subepicardial LS. As displayed in figure 1 (panels A-B-C), means ± SD were -20.8 ± 1.9% for LSsubendo, -19.2 ± 1.8% for LSsubepi and -19.9 ± 1.8% for LSmidwall. Accordingly higher value (95ile) for normal LS were -17.9%, -16.4% and -17.1% for LSsubepi, LSsubendo and LSmidwall, respectively. A significant subepicardial to subendocardial gradient was found in all children with higher absolute values found at the endocardial level, with a mean difference of 1.6 ± 0.9% (Panel D). CONCLUSIONS We provide preliminary data on 200 children to establish normal reference values for echocardiographic multilayer-specific strain measurement in a wide population of healthy italian children. Abstract P1542 Figure.

Clinical study of echocardiographic cardiac output monitor for hemodynamic monitoring after repair of ventricular septal defect in children

Objective To monitor the hemodynamics of children with congenital heart disease after operation by using ultrosonic cardiac output monitor (USCOM) to understand the changes of cardiac function in children with congenital heart disease after operation. Methods Twenty-four children with congenital heart disease underwent operation in the pediatric intensive care unit of Shengjing Hospital Affiliated to China Medical University from January 2017 to March 2018 were selected.Cardiac index (CI), lactate (Lac) concentration, central venous oxygen saturation (ScvO2), heart rate (HR) and mean arterial pressure (MAP) were recorded at four time points after operation by USCOM. Results The CI reached the highest level of 6.5L·min-1·(m2)-1 in 4h, the lowest level of 5L·min-1·(m2)-1 in 8h, and the same level in 24h as that in 1h.ScvO2 was correlated with CI: P values of 1h, 4h, 8h and 24h were 0.003, 0.02, 0.034 and 0.03, respectively (all P 0.05), and could not be used to judge the cardiac function of children with early congenital heart disease after operation. Conclusion USCOM is a non-invasive method for monitoring cardiac output, which can reflect the changes of cardiac function in children with congenital heart disease after operation. Key words: Heart septal defects, ventricular; Cardiac index; Ultrasonic cardiac output volume detector; Child

Comparison Of Pro-BNP Levels And Myocardial Performance Index Before And After Iron Treatment In Children With Congenital Cyanotic Heart Disease With Iron Deficiency Anemia

Introduction: Our aim was to compare NT-proBNP levels and cardiac functions after iron therapy in children with congenital cyanotic heart disease who had iron deficiency anemia.Materials and Methods: We included 40 children with pre-established cyanotic congenital heart disease and accompanying iron deficiency anemia, between the age of 6 months and 17 years, who were admitted to the outpatient clinic of Çukurova University Faculty of Medicine, Department of Pediatric Cardiology between September 2015 and March 2016. We recorded demographic data and performed following investigations: complete blood count, peripheral blood smear, reticulocyte count, measurement of serum iron levels, total iron-binding capacity, ferritin levels, transferrin saturation and NT-proBNP levels, and echocardiographic examination.Results: There was a statistically significant increase in following laboratory parameters after iron therapy: hemoglobin, hematocrit, MCV, MCHC, serum iron and ferritin, transferrin saturation and oxygen saturation. During the follow-up period, RDW and NT-proBNP levels were significantly decreased. In left ventricular tissue doppler; there was a significant difference in MPI measurements before and after treatment. There was no significant difference in other echocardiography findings. Conclusion: Iron therapy has improved cardiac functions in children with cyanotic congenital heart disease, and NT-proBNP levels can be used to evaluate the efficacy of treatment in the follow-up period.

Impaired Systolic and Diastolic Left Ventricular Function in Children with Chronic Kidney Disease - Results from the 4C Study

Children with chronic kidney disease suffer from excessive cardiovascular mortality and early alterations of the cardiovascular system. Tissue doppler imaging is a validated echocardiographic tool to assess early systolic and diastolic cardiac dysfunction. We hypothesized that tissue Doppler velocities would reveal reduced cardiac function in children with chronic kidney disease compared to healthy children. A standardized echocardiographic exam was performed in 128 patients of the Cardiovascular Comorbidity in Children with Chronic Kidney Disease (4C) Study aged 6–17 years with an estimated glomerular filtration rate (eGFR) below 60 ml/min/1.73 m2. Tissue Doppler measurements included early (E’) and late (A’) diastolic and systolic (S’) velocity at the mitral and septal annulus of the left ventricle. Measured values were normalized to z-scores using published reference data. Predictors of E’/A’, E/E’, S’ and left ventricular mass index (LVMI) were assessed by multiple linear regression analyses. Tissue Doppler E’ was reduced and tissue Doppler A’ increased, resulting in a reduced tissue Doppler E’/A’ ratio (z-score −0.14, p < 0.0001) indicating reduced diastolic function compared to healthy children. Reduced tissue Doppler E’/A’ Z-Scores were independently associated with lower eGFR (p = 0.002) and increased systolic blood pressure (p = 0.02). While E/E’ Z-Scores were increased (Z-score 0.57, p < 0.0001), patients treated with pharmacological RAS blockade but not with other antihypertensive treatments had significantly lower E/E’ and higher E’/A’ Z-Scores. Systolic tissue Doppler velocities were significantly decreased (Z-score −0.24, p = 0.001) and inversely correlated with E/E’ Z-Scores (r = −0.41, p < 0.0001). LVMI was not associated with systolic or diastolic tissue Doppler velocities. Concentric left ventricular hypertrophy showed a tendency to lower S’ in multivariate analysis (p = 0.13) but no association to diastolic function. Concentric left ventricular geometry was significantly associated with lower midwall fractional shortening. In summary, systolic and diastolic function assessed by tissue Doppler is impaired. eGFR, systolic blood pressure and the type of antihypertensive medications are significant predictors of diastolic function in children with CKD. Left ventricular morphology is largely independent of tissue Doppler velocities. Tissue Doppler velocities provide sensitive information about early left ventricular dysfunction in this population.

Carotid intima-media thickness and cardiac functions in children with neurofibromatosis type 1

Aim: Neurofibromatosis type 1 is a multisystem disorder, affecting primarily the skin, nervous and musculoskeletal systems. Various cardiovascular abnormalities, ranging from congenital heart disease to vasculopathy and hypertension are main clinical features of cardiovascular involvement. The aim of this study was to evaluate cardiac functions and carotid intima-media thickness by conventional and tissue Doppler echocardiography in terms of vasculopathy and cardiac involvement in children with neurofibromatosis type 1.Methods: A cross-sectional study is designed with 36 Neurofibromatosis patients (20 boy and 16 girl) as study group, with a mean age of 9.7(3.5) years with 36 healthy controls (18 males and 18 females) with a mean age of 10.3(2.2) years. Instant blood pressures were measured. Conventional and tissue Doppler echocardiography were performed. Carotid intima-media thickness, left ventricular ejection fraction and left ventricular fractional shortening were measured with M mode. Mitral early (E), late (A) flow velocities were measured by pulsed-wave Doppler, mitral early (E), late (A) flow velocities ratio was calculated. Tissue Doppler echocardiography was performed from the lateral annular junction of mitral valve and left ventricular myocardial performance index (Tei) index was calculated. Early diastolic flow (E') velocity was measured with tissue Doppler echocardiography.Results: Left ventricular systolic functions were normal in both groups. Mitral early flow velocities were lower (P&lt;0.001) in the study group. Also Mitral early / late velocities ratio was significantly lower (P=0.004) and mitral early flow velocity/ tissue Doppler early diastolic flow velocity ratio was higher (P=0.045) in the study group. The left ventricular Tei index was calculated as 0.42 (0.1) in the study group and 0.39 (0.1) in the healthy controls (P=0.03). The mean of carotid intima-media thickness was 0.46 (0.01) in the study group and 0.44 (0.01) in the control group (P=0.002). Systolic blood pressures were higher in the study group (P=0.04).Conclusion: Tei index and diastolic flow velocities in mitral valve support the left ventricle diastolic dysfunction in children with neurofibromatosis type 1. Carotid intima-media thickness suggests vasculopathy and early effects of hypertension due to neurofibromatosis type 1.

Impairment of left and right ventricular longitudinal strain in asymptomatic children with type 1 diabetes

AimThe relationship between type 1 diabetes (T1DM) and cardiac function in children is not well established. The purpose of this study was to investigate whether children and adolescents with T1DM present early asymptomatic abnormalities of left ventricular (LV) and right ventricular (RV) function. In addition, we evaluated the relationship of any such abnormalities with glycemic control and diabetes duration. MethodsThis was a prospective study. Standard echocardiography, tissue Doppler imaging, and two-dimensional strain analysis were performed prospectively in 52 children with T1DM. The results were compared with those from 52 healthy children matched for age and sex. ResultsThere were no significant differences between the two groups in LV ejection fraction or RV systolic function. There was a difference between the two study groups in transtricuspid flow: the E-wave and A-wave velocities were significantly higher in the diabetic group. Left ventricular global longitudinal strain (LV GLS) was significantly lower in children with T1DM (−20.01 ± 1.86% vs. −22.99 ± 0.98%, respectively; P < .001), as was RV free-wall longitudinal strain (RV FWLS) (−29.13 ± 1.85% vs. −30.22 ± 1.53%, respectively; P = .002). LV GLS was correlated with diabetes duration (r = 0.444, P < .001) and glycated hemoglobin (HbA1c) (r = 0.683, P < .001); however, no correlation was found between RV FWLS and HbA1c or diabetes duration. ConclusionsOur findings suggest that LV GLS and RV FWLS are impaired in children with T1DM and that the decrease in LV GLS is correlated with diabetes duration and HbA1c levels.

Effect of levothyroxine on cardiac function in children with subclinical hypothyroidism: A quasi-experimental study.

Background:Because of the importance of thyroid function and its effect on different organs, such as the heart, this study was aimed to evaluate the effect of levothyroxine on cardiac function in children with subclinical hypothyroidism.Methods:This quasi-experimental study was performed on children aged 4-12 years old with diagnosis of subclinical hypothyroidism in Amirkola Children's Hospital during 2018-2019. Cardiac functional parameters, including ejection fraction (EF), fractional shortening (FS), ratio of early filling velocity to early diastolic mitral annulus velocity (E/E'), myocardial performance index (MPI), left ventricular end-diastolic diameter (LVEDD), and left ventricular end-systolic diameter (LVESD), were measured by echocardiography at baseline and 6 months after levothyroxine treatment.Results:Out of the 30 subjects, 19 (63.3%) were boys and 11 (36.7%) were girls. The mean age was 6.60±2.13 years old. The mean EF index was 63.13±3.01 percent before treatment, which increased to 69.07±4.50 percent after treatment (p<0.001). Also, the mean FS was 31.83±1.62 percent before treatment, which improved to 35.10±1.13 percent after treatment (p<0.001). The mean MPI was 0.28±0.02 before treatment, which increased to 0.33±0.03 after treatment (p<0.001). On the other hand, no significant difference was found in the mean E/E' before and after treatment. The mean LVEDD decreased from 3.47±0.46 cm before treatment to 3.05±0.40 cm after treatment (p<0.001), whereas LVESD non-significantly decreased after treatment versus before treatment.Conclusion:The results showed that treatment with levothyroxine may improve cardiac functional parameters in children with subclinical hypothyroidism.

Cardiotoxicity in Children With Acute Ieukemia Treated by Anthracycline; Detected by Cardiac Troponins and Echcocardiography

Background and objectives:the use of anthracycline antineoplastic agents has conducted to improved pediatric malignancies’ outcomes, yet their use is limited by their potential cardiotoxic effects. Thus, children who have received anthracyclines require cardiac evaluation periodically. The serum levels of cardiac troponins have been shown to be elevated in response to severity of cardiac dysfunction. The aim of our study was to investigate the role of serum levels of cardiac troponin and echocardiography as sensitive markers for anthracycline-induced cardiotoxicity in children with malignancy. Methods:we carried out this study at Nanakali Hospital, Pediatric Hematology and Oncology unit. We measured plasma high sensitive cardiac troponin T in 24 patients who received anthracyclines for their malignancy at cumulative doses of 75-310mg/m2, between Feb 2017 and Feb 2018. Evaluation of the patients for cardiac functions included physical examination, chest X-ray and echocardiography in addition to cardiac troponins. Results: Of the 24 patients, 3 (12.5%) had abnormal cardiac functions by echocardiography. Serum troponin level in two of them was significantly elevated. Physical findings of the patients were significant. Chest X-ray in 2 (8.3%) showed radiological findings. Conclusions: Serum troponin concentration and Echocardiography may be practical and sensitive indicator of abnormal cardiac function in children receiving anthracycline therapy.

2D-Speckle tracking echocardiography contributes to early identification of impaired left ventricular myocardial function in children with chronic kidney disease.

The study included 38 children - 16 girls and 22 boys - diagnosed as having chronic kidney disease in the nephrology department with a glomerular filtration rate of <90 ml/minute/1.73 m2 for at least 3 months. A total of 37 - 15 girls and 22 boys - age- and sex-matched healthy children were included as the control group. 2D-Speckle tracking echocardiography was performed in all subjects. The mean age was 13.45±2.8 years in patients and 12.89±3.07 years in controls. Systolic and diastolic blood pressures and left ventricular mass index were significantly higher in patients (p<0.05). The values of mitral e, mitral a, mitral e/a ratio, and mitral deceleration time were not different between the groups. Tricuspid annular plane systolic excursion values were lower in patients (p<0.01). Global strain values in apical long-axis 3-chamber and 2-chamber views were significantly lower in patients (p<0.05). Longitudinal, radial, and circumferential peak systolic strain values were lower in patients, but the difference was statistically significant in all segments of longitudinal view and basal segment of circumferential view (p<0.05). Radial and circumferential systolic strain rates were significantly lower in patients in all three segments (p<0.05). Moreover, early diastolic strain rate was significantly lower in longitudinal and radial apical segments and in all segments of circumferential measurements in patients. Besides, strain rate e/a ratio was significantly lower in all longitudinal segments of patients (p=0.01). The study concluded that 2D-speckle tracking echocardiography method can determine cardiac involvement earlier than conventional echocardiography in children with chronic kidney disease having preserved ejection fraction.

R-Wave Modified Tissue Doppler Imaging Myocardial Performance Index for the Assessment of Cardiac Function in Children with Congestive Heart Failure: A Feasibility Study.

BackgroundThe aim of this study was to evaluate the feasibility of an R-wave modified tissue Doppler imaging (TDI) myocardial performance index (MPI), or MPI TDI-R, for the assessment of cardiac function in children with congestive heart failure (CHF).Material/MethodsForty children with CHF and 40 normal children were evaluated using the modified pediatric Ross heart failure grading system. TDI recorded the spectrum of diastolic function at the mitral valve annulus to measure the MPI. Twelve-lead electrocardiogram (ECG) measured the R-wave in the QRS complex, resulting in the modified MPI TDI-R. Correlation between the MPI TDI-R, other echocardiographic indices, and the Ross heart failure grades were analyzed, with reproducibility analysis.ResultsCompared with normal children, the MPI TDI and MPI TDI-R were significantly increased in the pediatric CHF group (P<0.01). The MPI TDI-R was significantly correlated with other indices of cardiac function and Ross grading for CHF in children (r=0.769). The MPI TDI-R showed good correlation with the findings of the MPI TDI, calculated by traditional methods. Receiver-operating characteristic (ROC) curve analysis showed that the MPI TDI-R had a sensitivity of 67.5%, and a specificity of 97.5%. The reproducibility of the MPI TDI-R was confirmed to be superior when compared with the non-modified MPI TDI.ConclusionsThis feasibility study showed that the modified MPI TDI-R, formed by combining the MPI TDI with synchronous surface ECG measurements, was simple to perform, reproducible, and provided a specific index for the assessment of cardiac function in children with CHF.

Cardiac Function in Children After Kidney Transplantation

Introduction The aim of the study was to evaluate early and long term systolic and diastolic heart functions in children with chronic kidney disease following renal transplantation. Materials and Methods Thirty children with chronic kidney disease (CKD) who received kidney transplant from 2011- 2017 were included in a retrospective study and compared with echocardiographic values at sequential intervals. Measurements of cardiac systolic and diastolic functions were performed via conventional and tissue Doppler echocardiography. Left ventricle, right ventricle and septal myocardial performance indices (MPI) were examined immediately before and after six month periods following kidney transplantation. Posttransplantation measurements were determined as early (firstyear) and long-term (longer than a year) functions and were compared each other. Results Twenty one boys and nine girls with median age of 13 years (5-19 years) were included. Before transplantation, left ventricle mean ejection fraction was 70% ± 7 (57-83) and systolic heart functions were normal in all. Left ventricle MPI was abnormal in 66% (20/30) and right ventricle MPI was abnormal in 90% (27/30). After transplantation, in the first year control left ventricle MPI was abnormal in 53% (16/30) but right ventricle MPI was abnormal in 70% (21/30). According the measurements longer than a year, left ventricle MPI was abnormal in 33% (10/30) but right ventricle MPI was still abnormal in 70% (21/30). Discussion Diastolic dysfunction with normal systolic function is determined even in early stages of CKD. Diastolic dysfunction persists after transplantation. Left ventricle structure and diastolic dysfunction could be reversed after transplantation but longer time may be needed for right ventricle recovery. Conclusion Right ventricle diastolic dysfunction must be kept in mind and examined.

Cardiac Iron Overload: Correlation between MRI T2* &amp; Two Dimensional Strain Echocardiography in Children with b-Thalassemia Major

AbstractBackground: b-thalassemia is a group of inherited blood disorders that causes iron overload in the heart. Development of overt heart failure is delayed till the second decade of life. Early detection of cardiac iron overload is necessary before development of heart failure.Aim of the Study: Was to evaluate cardiac function in children with b-thalassemia major having iron overload and to Compare MRI T2* and doppler echocardiography in dem-onstration of iron deposition in cardiac muscles in those patients.Patients and Methods: Fifty children with thalassemia major were subjected to history taking, clinical assessment, laboratory assessment, Doppler echocardiography and MRI for cardiac iron load assessment.Results: There is a negative correlation between cardiac MRI T2* with age, ferritin and serum iron level. As regard correltion between MRI and doppler echocardiography there is a positive correlation between MRI T2* and diastolic echocardiographic parameters Tei index in patients with thalassemia Major.Conclusion: There is a significant correlation between MRI T2* and Doppler echocardiography in patients with b thalassemia major.

Echocardiographic assessment of ventricular contraction and synchrony in children with isolated complete atrioventricular block and epicardial pacing: Implications of interventricular mechanical delay.

To assess the correlations between interventricular mechanical delay (IVMD) and cardiac function in children with isolated complete atrioventricular block and epicardial pacing. We enrolled 13 children (six boys) with an epicardial dual-chamber pacemaker due to isolated complete or advanced atrioventricular block. The patients were 9.8 (range, 6.8-15.3) years old, and none had symptomatic heart failure at the follow-up visit. Ventricular pacing sites, which remained the same for 7.2 (1.6-12.3) years, were the left ventricle (LV) in two patients, right ventricle (RV) in four patients, and both ventricles in seven patients. IVMD was ≤40ms in six patients (short IVMD group) and >40ms in seven patients (long IVMD group). Compared with the long IVMD group, the short IVMD group was associated with better LV longitudinal strain (-20% [-24% to -18%] vs -16% [-20% to -13%], P<.05). The short IVMD group had superior LV mechanical synchrony than the long IVMD group (septal to lateral delay of the time to peak longitudinal strain 15 [-16-78] ms vs 78 [13-93] ms, P<.05; standard deviation of the time to peak radial strain 13 [9-34] ms vs 35 [18-64] ms, P<.05). In children with epicardial pacing at LV, RV, or both ventricles, a left-sided contraction delay was associated with poorer LV contraction and impaired LV synchrony. IVMD will help to stratify patients during follow-up.

Cardiac function in children with premature ventricular contractions: the effect of omega-3 polyunsaturated fatty acid supplementation.

Premature ventricular contractions are accepted as benign in structurally normal hearts. However, reversible cardiomyopathy can sometimes develop. Omega-3 polyunsaturated fatty acids have anti-arrhythmic properties in animals and humans.AimWe evaluated left ventricular function in children with premature ventricular contractions with normal cardiac anatomy and assessed the impact of omega-3 fatty acid supplementation on left ventricular function in a prospective trial. A total of 25 patients with premature ventricular contraction, with more than 2% premature ventricular contractions on 24-hour Holter electrocardiography, and 30 healthy patients were included into study. All patients underwent electrocardiography, left ventricular M-mode echocardiography, and myocardial performance index testing. Patients with premature ventricular contraction were given omega-3 fatty acids at a dose of 1 g/day for 3 months, and control echocardiography and 24-hour Holter electrocardiography were performed. Neither placebo nor omega-3 fatty acids were given to the control group. Compared with the values of the control group, the patients with premature ventricular contraction had significantly lower fractional shortening. The myocardial performance index decreased markedly in the patient groups. The mean heart rate and mean premature ventricular contraction percentage of Group 2 significantly decreased in comparison with their baseline values after the omega-3 supplementation. In conclusion, premature ventricular contractions can lead to systolic cardiac dysfunction in children. Omega-3 supplementation may improve cardiac function in children with premature ventricular contractions. This is the first study conducted in children to investigate the possible role of omega-3 fatty acid supplementation on treatment of premature ventricular contractions.

Cardiac Autonomic Nervous System Activity and Cardiac Function in Children After Coarctation Repair

Coarctation of the aorta (CoA) is one of the most common congenital heart defects. Most patients live into adulthood as a result of improved surgical techniques; however, late complications, including hypertension, recoarctation, and arrhythmias, are common. The autonomic nervous system (ANS) might play a role in the pathology. This study evaluated cardiac ANS activity and cardiac function in children after CoA repair and investigated the relationship between the two. The study participants were 31 children after CoA repair and 62 healthy controls aged between 8 and 18 years. Ambulatory impedance cardiography was used to measure cardiac ANS activity and cardiac output for 24 hours. Transthoracic echocardiography and cardiac magnetic resonance imaging were used to measure cardiac function. No group differences were found in ambulatory cardiac ANS activity. However, ambulatory cardiac output and left ventricular function were significantly decreased in patients compared with controls. Left ventricular function and ambulatory cardiac output are impaired in patients after CoA repair, despite unchanged cardiac ANS activity in this group. These results underscore the importance of clinical follow-up, even in patients without residual stenosis.

Asymmetric dimethylarginine levels and diabetes duration: Relationship with measures of subclinical atherosclerosis and cardiac function in children and adolescents with Type 1 diabetes.

We aimed to evaluate asymmetric dimethylarginine levels in young patients with Type 1 diabetes mellitus according to diabetes duration and to examine the relationship between these levels and measures of atherosclerosis and myocardial function. In total, 83 patients (8.5-22 years) with Type 1 diabetes mellitus were stratified by diabetes duration: 12-60 months (Group 1, n = 27), >60-120 months (Group 2, n = 29) and >120 months (Group 3, n = 27). Asymmetric dimethylarginine levels were assessed. Carotid intima-media thickness was measured. Myocardial function was assessed by M-mode, conventional Doppler and tissue Doppler echocardiography. Asymmetric dimethylarginine level was significantly higher in Group 1, while carotid intima-media thickness was significantly greater in Group 3 ( p < 0.05). Tissue Doppler echocardiography showed the ratio of peak early to peak late diastolic myocardial annular velocity decreased significantly in Groups 2 and 3 with a negative correlation with duration (r: -0.310, p = 0.004) and HBA1c levels (r = -0.391, p < 0.001). Myocardial performance index in all groups and isovolumic relaxation time in Group 3 increased significantly. Asymmetric dimethylarginine levels were negatively correlated with carotid intima-media thickness and isovolumic relaxation time ( p < 0.05). In contrast to adult diabetics, asymmetric dimethylarginine concentration decreases as diabetes duration increases in young Type 1 diabetic patients and is associated with worsening measures of cardiovascular risk and poorer diastolic function.

Assessment of Myocardial Function and Injury by Echocardiography and Cardiac Biomarkers in African Children With Severe Plasmodium falciparum Malaria.

Perturbed hemodynamic function complicates severe malaria. The Fluid Expansion as Supportive Therapy trial demonstrated that fluid resuscitation, involving children with severe malaria, was associated with increased mortality, primarily due to cardiovascular collapse, suggesting that myocardial dysfunction may have a role. The aim of this study was to characterize cardiac function in children with severe malaria. A prospective observational study with clinical, laboratory, and echocardiographic data collected at presentation (T0) and 24 hours (T1) in children with severe malaria. Cardiac index and ejection fraction were calculated at T0 and T1. Cardiac troponin I and brain natriuretic peptide were measured at T0. We compared clinical and echocardiographic variables in children with and without severe malarial anemia (hemoglobin < 5 mg/dL) at T0 and T1. Mbale Regional Referral Hospital. Children 3 months to 12 years old with severe falciparum malaria. Usual care. We enrolled 104 children, median age 23.3 months, including 61 children with severe malarial anemia. Cardiac troponin I levels were elevated (> 0.1 ng/mL) in n equals to 50, (48%), and median brain natriuretic peptide was within normal range (69.1 pg/mL; interquartile range, 48.4-90.8). At T0, median Cardiac index was significantly higher in the severe malarial anemia versus nonsevere malarial anemia group (6.89 vs 5.28 L/min/m) (p = 0.001), which normalized in both groups at T1 (5.60 vs 5.13 L/min/m) (p = 0.452). Cardiac index negatively correlated with hemoglobin, r equals to -0.380 (p < 0.001). Four patients (3.8%) had evidence of depressed cardiac systolic function (ejection fraction < 45%). Overall, six children died, none developed pulmonary edema, biventricular failure, or required diuretic treatment. Elevation of cardiac index, due to increased stroke volume, in severe malaria is a physiologic response to circulatory compromise and correlates with anemia. Following whole blood transfusion and antimalarial therapy, cardiac index in severe malarial anemia returns to normal. The majority (> 96%) of children with severe malaria have preserved myocardial systolic function. Although there is evidence for myocardial injury (elevated cardiac troponin I), this does not correlate with cardiac dysfunction.