Background Subclinical diastolic dysfunction in patients with Type 1 diabetes mellitus (T1DM) caused by myocardial injury due to diabetic cardiomyopathy leads to a high risk of death and heart failure. This myocardial injury extends not only to the left ventricle (LV) but also to the left atrium (LA). However, LA function in children and young adults with T1DM has not been extensively studied. Objective Therefore, the aim of this study was to assess LA dysfunction in pediatric and adult patients with T1DM using LA strain analysis with echocardiography. Subjects Fifty‐three patients (median age: 23 [range: 5–41] years) with T1DM. Methods We divided the patients into three age groups (D1: 5–14 years, D2: 15–24 years, D3: 25–41 years); 53 age‐ and sex‐matched controls were divided into three corresponding groups (C1, C2, and C3). LA and LV functions were evaluated using echocardiography. Results LA reservoir strain was lower in the D2 and D3 groups than in the C2 and C3 groups (P = 0.001, P = 0.004, respectively). LA conduit strain was lower in the D2 group than in the C2 group (P = 0.002). LA stiffness was significantly greater in the D3 group than in the C3 group (P < 0.001). Conclusions In patients with T1DM, LA phasic function decreased in adolescents and young adults, and LA stiffness increased in adult patients aged >30 years. LA phasic function and LA stiffness can be potentially used as early markers for diastolic dysfunction.

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A 14-year-old girl with recurrent episodes of transient loss of consciousness (T-LOC) during physical activities was presented to our hospital accompanied by her mother. She was started on lamotrigine on suspicion of epilepsy. Further investigations were conducted since there was no improvement. e electrophysiology study was normal, but the cardiac computed tomography (CT) showed an abnormal origin of the right coronary artery, which was interarterial (running between the aorta and pulmonary artery but had no intramural course). e exercise stress test revealed no evidence of myocardial ischemia. Electroencephalography (EEG) ndings were atypical, and the T-LOC episodes during physical activity, which are rare in epileptic seizures, made it di cult to di erentiate between cardiogenic syncope and epilepsy. erefore, an insertable cardiac monitor (ICM) was implanted. A er implantation, the ICM recordings showed that the T-LOC episodes were not accompanied by any arrhythmias. However, electromyography (EMG) activity was suspicious of a seizure. Based on these results and the clinical ndings, we concluded that the T-LOC was due to focal to bilateral tonic-clonic seizures (FBTCS), and concomitant use of lacosamide helped in marked relief of the patientʼs symptoms. ICM proves to be e ective in children with T-LOC that is di cult to diagnose.

Background Patients with inflammatory bowel disease (IBD) are at a higher risk of developing cardiovascular diseases than healthy individuals, owing to persistent chronic inflammation and treatment effects. This study aimed to assess left ventricular function in patients with childhood-onset IBD using layer-specific strain analysis and to identify early indicators of cardiac dysfunction in them. Methods A total of 47 patients with childhood-onset ulcerative colitis (UC), 20 patients with Crohn’s disease (CD), and 75 age- and sex-matched healthy control subjects were included in this study. Conventional echocardiographic measurements of layer-specific (ie, endocardium, midmyocardium, and epicardium) global longitudinal strain and global circumferential strain (GCS) were evaluated in these participants. Results Layer-specific strain analysis showed that global longitudinal strain was lower in all layers for the UC (P &lt; .001) and CD (P &lt; .001) groups, regardless of the age at onset, but that GCS was only lower in the midmyocardial (P = .032) and epicardial (P = .018) layers in the CD group than in the control group. Although the mean left ventricular wall thickness was not significantly different among the groups, it was significantly correlated with the GCS of the endocardial layer in the CD group (ρ= -0.615; P = .004), suggesting that thickening of the left ventricular wall occurred as a compensatory mechanism to maintain the endocardial strain in the CD group layer. Conclusions Children and young adults with childhood-onset IBD displayed decreased midmyocardial deformation. Layer-specific strain could also be useful to identify indicators of cardiac dysfunction in patients with IBD.

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