Speckle Tracking Stress Echocardiography Uncovers Early Subclinical Cardiac Involvement in Pediatric Patients with Inflammatory Bowel Diseases

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.

Cardiac functions and aortic elasticity in children with inflammatory bowel disease: effect of age at disease onset

“…In previous studies, diastolic dysfunction was shown in both paediatric and adult inflammatory bowel disease patients. 11,29 Also, diastolic dysfunction was found to be correlated to coronary microvascular dysfunction in adult patients with no coronary risk factors in inflammatory bowel disease patients. 30 Early-onset inflammatory bowel disease defined as a monogenic inflammatory bowel disease group which is characterised with hyperinflammation and accompanied by autoinflammatory disorders.…”

“…33 Left ventricular myocardial performance parameters were found to be depressed by speckle tracking echocardiography in inflammatory bowel disease. 11,29 In our study, we determined increase in septal and left ventricular end-systolic diameter in patients with early-onset inflammatory bowel disease. We can conclude that precaution in cardiac evaluation is necessary in early-onset inflammatory bowel disease subgroup.…”

“…Although pulse wave velocity is the recommended method for determination of aortic elasticity properties in both children and adults, transthoracic echocardiographic evaluation of aortic elasticity is feasible. 33,29…”

Capabilities and Limitations of Speckle Tracking Stress Echocardiography

“…Выполнение проб с физической нагрузкой с одновременной эхокардиографической оценкой систолической, диастолической функций ЛЖ и клапанного аппарата позволяет выявить взаимосвязь между симптомами, функциональной способностью пациента и гемодинамическими реакциями на нагрузку [8]. Появляются работы по исследованию возможностей применения технологии спекл-трекинг при стресс-эхокардиографии для оценки деформации миокарда ЛЖ [15][16][17].…”

Novel functional advanced echocardiography for the assessment of myocardial mechanics in children with neurocardiogenic syncope – a blinded prospective speckle tracking head-up tilt-table challenge study

“…STE is reproducible tool for the detection of myocardial strain and strain rate [ 11 , 12 ]. It has been successfully used to detect subclinical myocardial dysfunction in a variety of clinical settings such as arterial hypertension [ 13 ], systemic inflammatory disease [ 14 ], diabetes mellitus [ 15 ] and short-term alterations of glucose metabolism [ 16 ]. In 2013, the “ventricular theory” was fundamentally questioned by Goel et al as they reported a paradoxical decrease of LV strain in adults with neurally mediated syncope and a positive head-up tilt-table (HUTT) exam utilizing STE [ 17 ].…”