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Introduction. Pathological left ventricular (LV) remodeling in children with metabolic syndrome (MS) is associated with a significant increase in cardiometabolic risk. However, data regarding the prevalence of LV remodeling patterns in children with MS are limited. Material and methods. An observational analytical cohort study was conducted on 145 children. The diagnosis of MS was established according to the International Diabetes Federation (IDF) criteria. We analyzed the echocardiography, as well as clinical and paraclinical data. Participants were distributed, depending on LV mass index and relative wall thickness into four LV geometric patterns as recommended by American and European Society of Echocardiography: normal geometry, concentric left ventricular remodeling (cLVR), concentric left ventricular hypertrophy (cLVH), and eccentric left ventricular hypertrophy (eLVH). Results. The pathological remodeling patterns were distributed as follows: 62.1% (n=90) participants showed a normal LV geometry pattern, 27.6% (n=40)-cLVH, 5.5% (n=8)-cLVR and 4.8% (n=7)-eLVH. In terms of presence/absence of MS, 54.7% (n=29) participants from the research group showed a normal LV geometry pattern, 32.1% (n=17)-cLVH, 5.7% (n=3)-cLVR and 7.5% (n=4)-eLVH, whereas 66.3% (n=61) participants from the control group presented normal LV geometric appearance, 25% (n=23)-cLVH, 5.4% (n=5)-cLVR and 3.3% (n=3)-eLVR (χ2=0.52; p>0.05). Conclusions. Concentric left ventricular hypertrophy was the commonest LV geometric pattern among the subjects with metabolic syndrome. Concentric left ventricular remodeling and eccentric left ventricular hypertrophy were rare among the study population. Cuvinte cheie: sindrom metabolic, copii, modele de remodelare a ventriculului stâng. MODELE DE REMODELARE VENTRICULARĂ STÂNGĂ LA COPIII CU SINDROM METABOLIC Introducere. Remodelarea patologică a ventriculului stâng (VS) la copiii cu sindrom metabolic (SM) este asociată cu o creștere semnificativă a riscului cardiometabolic. Cu toate acestea, date privind prevalența paternelor de remodelare ale VS la copiii cu SM sunt limitate. Material și metode. Studiu analitic, observațional, de cohortă. Au fost incluși 145 de copii. Diagnosticul de SM a fost stabilit conform criteriilor Federației Internaționale de Diabet (FID). Am analizat datele clinice, paraclinice și ecocardiografice. Participanții au fost stratificați în patru tipare geometrice, folosind indicele de masă a VS și grosimea relativă a PPVS, așa cum recomandă Societatea Americană și Europeană de Ecocardiografie: geometrie normală VS, remodelare concentrică VS (RC VS), hipertrofie concentrică VS (HC VS) și hipertrofie excentrică VS (HE VS). Rezultate. Tipurile de remodelare patologică s-au repartizat în felul următor: 62.1% (n=90) participanți au prezentat aspect geometric normal al VS, la 27,6% (n=40) dintre ei s-a înregistrat HC VS, la 5,5% (n=8) participanți s-a atestat RC VS, iar 4,8% (n=7) din acest lot au prezentat HE VS. În funcție de prezența/absența SM, în lotul de bază, 54,7% (n=29) participan...

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Objective: Approximately 20% of patients with HBV infection have a wide range of extrahepatic damages that include renal and cardiovascular abnormalities. The purpose: is to highlight the cause of hypertension in a child with viral hepatitis B and multiorgan damage. Design and method: Describing a clinical case of a child with occult hepatitits. Results: A 1-year-old girl with toxic syndromes was hospitalized in Pediatric Department. Anamnestic data: the mother was diagnosed with HBsAg positive 4 years ago. The child was vaccinated with all 4 scheduled doses of anti-HBV vaccine. At first examination - increased BP values (160–220/100–120 mm/Hg), tachycardia, hepatomegaly. Laboratory tests: anemia gr. II, hypoproteinemia, hypoalbuminemia, hypocalcemia, slightly elevated transaminases. Ecocardiography - cardiac remodeling with dilated lef ventricle (LV); hypokinesia, and mild hypertrophy of interventricular septum; LV ejection fraction - 47%. The secondary causes of arterial hypertension have been investigated: concentration of fractionated urinary and plasma metanephrines - N, direct plasma renin - > 5000 UI/mL, and serum aldosterone - 128 ng / dL. The aldosterone/renin ratio was 0.025 - suggestion of renal ischemia with secondary hyperaldosteronism. Cardiac and abdominal angioCT - severe hypoplasia of the common hepatic artery, moderate diffuse stenosis of the abdominal aorta at the renal and infrarenal levels, moderate diffuse stenosis of the bilateral renal arteries, more pronounced on the right, bilateral renal atrophy changes; cateterism cardiac - the aorta is permeable throughout, stenosis on the renal arteries, celiac trunk, and mesenteric artery was not determined, data that allowed the exclusion of the renovascular cause of hypertension. Abdominal MRI - focal areas 7x8 mm of diffusion restriction in the bilateral renal parenchymal. The patient was suspected of an HBV infection with a risk of perinatal transmission, after in dynamics, there was identified hepatomegaly (+3.0 cm) and elevated ALAT and ASAT. Quantitative plasma HBV DNA -1 418 771 300 copies/ml or 834 571 352 IU/ml, which confirmed the diagnosis - Occult viral hepatitis B, gr. III of activity, seropositive form, with extrahepatic cardiorenal impairment. Conclusions: Cardiorenal impairment should be suspected in patients with HBV infection, especially in presence of clinical signs.

Objective: Introduction: Duchenne muscular dystrophy (DMD) is one of many neuromuscular diseases, that commonly creates severe disability and early death. Cardiomyopathy associated with DMD is an increasingly acknowledged presentation of this neuromuscular disorder, significantly increasing morbidity and mortality, as well as the requirement for cardiological treatment. Design and method: Purpose: is to review literature data relatively the presence of elevated blood pressure values and body mass index in children with DMD and their impact on the development of heart disease. Results: Several studies have published cross-sectional data about the prevalence of hypertension and increased BMI in children with DMD. Wong et al., 2017 reported that 25.5% of patients on daily steroids aged 10–13 years had systolic hypertension. In patients aged 13–16 years, they reported systolic hypertension in 10.3% of patients. Corticosteroid treatment is thus an essential part of the standards of care in DMD and is recommended from the age of 4 to 5 years onward. Ricotti et al., 2013 observed hypertension in 5% of the patients aged 3–15 years on intermittent steroids while in a study by Braat et al., 2015, 45% of the patients had hypertension. In N.M. van de Velde et al., 2019, study increased BMI, but not systolic blood pressure, was related to early myocardial deformation defined by peak systolic GLS in young DMD patients < 11 years of age. Prevalence of obesity has been described up to 73% in steroid-native DMD patients < 13 years and higher BMI was associated with longer duration and higher cumulative dose in ambulant DMD patients using prednisone (Lamb et al., 2016). In Barber et al. study, 2013 use of corticosteroids has managed to prolongation of the ambulant stage in DMD by almost 3 years. It has also been correlated with a delayed onset of dystrophinic cardiomyopathy in Markham et al., 2008 and Davidson et al., 2014 studies. Conclusions: The results of this review suggest that factors influencing afterload, such as increased blood pressure and BMI, may play a role in the deterioration of cardiac function in DMD.