Risk of Idiopathic Dilated Cardiomyopathy in 29 000 Patients With Celiac Disease

Emilsson, Louise; Andersson, Bert; Elfström, Peter; Green, Peter H.R.; Ludvigsson, Jonas F.

doi:10.1161/jaha.112.001594

Cited by 40 publications

(28 citation statements)

References 36 publications

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“…Although the association of CD with DCM has been described in many studies on adult population,[25] published data in pediatric populations are few. In a study conducted by Zahmatkeshan et al .…”

Section: Discussionmentioning

confidence: 99%

Cardiac functions assessment in children with celiac disease and its correlation with the degree of mucosal injury: Doppler tissue imaging study

Fathy¹,

Abo‐Haded²,

Al-Ahmadi³

et al. 2016

Saudi J Gastroenterol

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Background/Aims:Celiac disease (CD)-associated cardiologic disorders is a growing concern. However, data regarding cardiac affection in children with CD are few. This study aimed at assessing the subclinical impact of CD on the global myocardial performance in Saudi children with CD using Doppler tissue imaging (DTI).Patients and Methods:Conventional two-dimensional echocardiography was performed among 20 Saudi children with CDas well as 20 age and sex-matched healthy controls. DTI were used to determine right ventricular (RV) and left ventricular (LV) Tei indexes. These findings were correlated with the Modified Marsh Classification of the histologic findings in CD.Results:LV and RV Tei indexes were significantly higher in children with CD than the control group (mean ± standard deviation: 0.47 ± 0.05 vs. 0.31 ± 0.18; P < 0.0005 and 0.51 ± 0.04 vs. 0.32 ± 0.05; P < 0.0001, respectively). RV Tei index was found to be positively correlated with the Modified Marsh Classification of CD (r = 0.7753, P < 0.0001). LV Tei index tended to be more affected in patients with more severe histologic findings, however, such relation did not reach statistical significance (r = 0.2479, P = 0.292). Fractional shortening did not correlate with the Modified Marsh Classification of histologic findings in CD patients (r= −0.11, P = 0.641).Conclusions:Subclinical myocardial dysfunction of both ventricles occurs in children with CD. The DTI method appears to be more sensitive than conventional two-dimensional echocardiography in the early detection of myocardial dysfunction in children with CD.

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Section: Discussionmentioning

confidence: 99%

Cardiac functions assessment in children with celiac disease and its correlation with the degree of mucosal injury: Doppler tissue imaging study

Fathy¹,

Abo‐Haded²,

Al-Ahmadi³

et al. 2016

Saudi J Gastroenterol

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“…Conversely, in a recent nationwide study, it was found that patients with CD had a moderately but not statistically significantly increased risk of idiopathic DCM (HR 1.73; 95% CI, 1.00–3.00) [180]. In these patients, a GFD may have a beneficial effect with improvement of echocardiographic parameters as well as in cardiological features and quality of life [178, 181].…”

Section: Autoimmune Disorders In Celiac Diseasementioning

confidence: 99%

Celiac Disease and Autoimmune-Associated Conditions

Lauret

Rodrigo

2013

BioMed Research International

152

111

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Celiac disease (CD) is frequently accompanied by a variety of extradigestive manifestations, thus making it a systemic disease rather than a disease limited to the gastrointestinal tract. This is primarily explained by the fact that CD belongs to the group of autoimmune diseases. The only one with a known etiology is related to a permanent intolerance to gluten. Remarkable breakthroughs have been achieved in the last decades, due to a greater interest in the diagnosis of atypical and asymptomatic patients, which are more frequent in adults. The known presence of several associated diseases provides guidance in the search of oligosymptomatic cases as well as studies performed in relatives of patients with CD. The causes for the onset and manifestation of associated diseases are diverse; some share a similar genetic base, like type 1 diabetes mellitus (T1D); others share pathogenic mechanisms, and yet, others are of unknown nature. General practitioners and other specialists must remember that CD may debut with extraintestinal manifestations, and associated illnesses may appear both at the time of diagnosis and throughout the evolution of the disease. The implementation of a gluten-free diet (GFD) improves the overall clinical course and influences the evolution of the associated diseases. In some cases, such as iron deficiency anemia, the GFD contributes to its disappearance. In other disorders, like T1D, this allows a better control of the disease. In several other complications and/or associated diseases, an adequate adherence to a GFD may slow down their evolution, especially if implemented during an early stage.

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“…In a subsequent nationwide Swedish study, 29 000 patients with coeliac disease were followed up for the subsequent development of dilated cardiomyopathy. Compared to controls, coeliac patients had a slightly increased risk of developing dilated cardiomyopathy that fell just short of statistical significance 18. The most plausible explanation for any link between coeliac disease and dilated cardiomyopathy is that both conditions might be mediated through inflammation and autoimmune mechanisms.…”

Section: Discussionmentioning

confidence: 93%

Cardiomyopathy responsive to gluten withdrawal in a patient with coeliac disease

2016

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A 57-year-old man with iron deficiency anaemia developed general malaise, exertional dyspnoea and features of cardiac failure out of proportion to his anaemia (haemoglobin 120 g/L). Investigations showed a severely dilated left ventricle with an ejection fraction of 15%, due to dilated cardiomyopathy. He was treated with high-dose diuretics, ACE inhibitors and β-blocker therapy. Subsequent investigation into his iron deficiency anaemia revealed a new diagnosis of coeliac disease. After starting a gluten-free diet, his cardiac function improved markedly, with ejection fraction reaching 70%, allowing his cardiac medications to be withdrawn. This case suggests a link between coeliac disease and cardiomyopathy.

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Risk of Idiopathic Dilated Cardiomyopathy in 29 000 Patients With Celiac Disease

Cited by 40 publications

References 36 publications

Cardiac functions assessment in children with celiac disease and its correlation with the degree of mucosal injury: Doppler tissue imaging study

Cardiac functions assessment in children with celiac disease and its correlation with the degree of mucosal injury: Doppler tissue imaging study

Celiac Disease and Autoimmune-Associated Conditions

Cardiomyopathy responsive to gluten withdrawal in a patient with coeliac disease

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