QT and P-wave dispersions in rheumatic heart disease: prospective long-term follow up.

BACKGROUND: Simple electrocardiogram (ECG) markers have been used to evaluate conduction times. Acute rheumatic fever (ARF) is an autoimmune disease that affects these conduction times. The aim of this prospective long-term follow-up study was to evaluate QT, QTc and P-wave dispersions in children with ARF and chronic rheumatic heart disease (CRHD). METHODS: Sixty-four patients with ARF, 33 patients with CRHD and 41 healthy, age- and sex-matched control subjects were included in the study. The ARF patients were divided into two subgroups: carditis and arthritis. Echocardiographic and ECG measurements at the onset of diagnosis and final evaluation were included. RESULTS: QT, QTc and P-wave dispersions were significantly greater in both the ARF carditis and CRHD groups than the ARF arthritis and control subjects during the initial and final analysis (for all, P < 0.001). There was no significant statistical difference in QT, QTc and P-wave dispersion between the initial and final analysis in each groups. Severity of mitral regurgitation and left atrial enlargement were found to be positively correlated with P-wave dispersion (r = 0.438, P < 0.001; r = 0.127, P < 0.001, respectively). QT, QTc and P-wave dispersion greater than 52, 60 and 57 ms, respectively, had higher sensitivity and specificity for predicting ARF carditis. CONCLUSION: These ECG measurements can be used in the diagnosis of ARF carditis as minor criteria with modified Jones criteria. In contrast, this increase in the dispersions is permanent in patients with ARF carditis.

Dispersion durations of P-wave and QT interval in children with congenital heart disease and pulmonary arterial hypertension.

This study aimed to investigate homogeneity disorders of ventricular repolarization and atrial conduction via QT dispersion and P-wave dispersion in children with congenital heart disease (CHD) and pulmonary arterial hypertension (PAH). Three groups of 20 each were generated and involved in this study. The first group included 20 children with both CHD and PAH. The second group consisted of 20 children with CHD but no PAH, and the third group was composed of 20 age- and sex-matched healthy children. Electrocardiographic records were used to determine P-wave, QT, and corrected QT (QTc) dispersions. The pulmonary hypertension group compared with the group having no pulmonary hypertension and the control group showed a significantly longer P-wave dispersion duration (39.10 ± 9.54 vs. 26.30 ± 4.99 ms, p < 0.001; and 24.80 ± 6.94 ms, p < 0.001, respectively) and QT dispersion duration (52.80 ± 15.11 vs. 37.60 ± 6.00 ms, p < 0.001; and 35.00 ± 7.77 ms, p < 0.001, respectively). In addition, the durations of maximum QTc and QTc dispersion were significantly longer in pulmonary hypertension group than in the other two groups. The risk of atrial and ventricular arrhythmia was found to be increased in the patients with both CHD and PAH. Physicians should pay close attention to possible atrial and ventricular arrhythmias during the treatment and follow-up evaluation of these patients.

PHACE syndrome with growth hormone deficiency and absence of bilateral internal carotid arteries: a case report.

PHACE syndrome is characterized by posterior fossa malformations (P), large facial hemangiomas (H), arterial anomalies (A), cardiac anomalies or coarctation of aorta (C), and eye anomalies (E) and has striking female predominance. Endocrine abnormalities have recently been described in these patients, involving the thyroid and pituitary glands. We report the case of a 2-year-old girl with the clinical features of PHACE with absence of bilateral internal carotid arteries and isolated growth hormone deficiency.

[Ventricular septal defect developed due to coronary artery injury after blunt chest trauma in childhood]. / Cocukluk döneminde künt gögüs travmasi sonrasi koroner arter zedelenmesine bagli gelisen ventriküler septal defekt.

In the literature, cardiac response associated with blunt chest trauma in children has been reported generally as case reports, and interventricular septal rupture due to trauma is quite rare. Interventricular septal rupture can develop even in the absence of visible signs of a trauma because of the flexibility of the chest structure in children. In the present case, a seven-year-old boy with interventricular septal rupture at the mid-muscular region and left ventricle pseudoaneurysm developed due to injury to the left anterior descending coronary artery after a traffic accident is reported. Patients with cardiac murmur detected on physical examination after a blunt chest trauma must be considered as cardiac injury, and in those with signs of ischemia detected on electrocardiography, it should not be forgotten that the coronary artery may be affected.

Evaluation of serum ischemia modified albumin levels in acute rheumatic fever before and after therapy.

OBJECTIVE: To investigate ischemia modified albumin (IMA) levels in children with acute rheumatic fever (ARF) before and after therapy and compare them with those of controls. METHODS: Twenty seven patients with ARF and 18 healthy, age and sex matched children were included in the study. The diagnosis of ARF was established according to the modified Jones criteria. Follow-up studies were made when acute phase reactants [erythrocyte sedimentation rate (ESR), C-reactive protein (CRP)] levels returned normal. IMA levels were measured using the rapid and colorimetric method with the albumin cobalt binding test. RESULTS: IMA levels were significantly higher in ARF group (p < 0.001) compared with controls at the time on admission. IMA (absorbance units) was measured as 0.41 ± 0.10 in the control group, 0.55 (0.44-1.13) in the study group before treatment and 0.48 ± 0.12 in the study group after treatment. After treatment, statistically important decrements were determined in the levels of ESR (p<0.001), CRP (p<0.001) and IMA (p<0.01). There was no significant difference for IMA levels between after treatment and control group. IMA levels at the time on admission correlated positively with ESR (r = 0.605, p < 0.01) and CRP (r = 0.543, p < 0.01). CONCLUSIONS: The present study shows that increased serum IMA levels in patients with ARF at the time of diagnosis is a sign of increased inflammation. Thus, serum IMA levels may be used as a follow-up marker like CRP and ESR for evaluating the efficacy of treatment in ARF.

Evaluation of epicardial adipose tissue, carotid intima-media thickness and ventricular functions in obese children and adolescents.

BACKGROUND: Childhood obesity is a cardiovascular risk factor. OBJECTIVE: Epicardial adipose tissue (EAT) thickness, carotid intima-media thickness (IMT) and cardiac functions of obese children and their correlations were evaluated. SUBJECTS: Five hundred obese children and 150 age- and sex-matched healthy controls. METHODS: Anthropometric, laboratory data and echocardiographic measurements of IMT, EAT and cardiac functions were determined. RESULTS: Increased M-mode echocardiographic measurements, E/e' ratios, Tei index values and decreased E/A and e'/a' ratios (where E and A are early and late mitral/tricuspid diastolic velocities, respectively, and e' and a' are peak early diastolic and peak atrial systolic myocardial velocities, respectively), were determined in the obese group. Also, carotid artery IMT and EAT thickness were significantly higher in obese children. Carotid artery IMT, EAT thickness and left ventricular mass (LVM) were found to be strongly associated with Tei index values. CONCLUSION: Obesity is a major risk factor for cardiovascular diseases. In our study, we showed that obese children have early subclinical systolic and diastolic dysfunctions. Also, these cardiac impairments are correlated with the increase in IMT, EAT thickness and LVM.

The role of tenascin-C and oxidative stress in rheumatic and congenital heart valve diseases: an observational study.

OBJECTIVE: The aim of this study was to evaluate the association of tenascin-C (TnC) and total oxidant-antioxidant status to rheumatic or congenital heart valve diseases (HVD) in pediatric patients. METHODS: Fifty pediatric patients (25 rheumatic HVD patients and 25 congenital HVD patients) and 20 healthy age-matched control subjects, aged 3-17 years, were enrolled in this observational and cross-sectional study. Serum total antioxidant capacity (TAC), total oxidant status (TOS), oxidative stress index (OSI) and TnC levels were compared among the groups. ANOVA and Kruskal-Wallis tests were used for statistical analysis. RESULTS: Serum TnC level of the patients with rheumatic HVD [median 9.09 (0.94-46.30) ng/mL] was significantly higher than both congenital HVD and control groups [median 2.97 (0.66-11.80) ng/mL; p<0.01, 4.72±1.77 ng/mL; p<0.05, respectively]. However, there was no statistically significant difference between the congenital and control groups in terms of serum TnC level. The levels of serum TAC, TOS and OSI were found to be statistically similar in all groups. In addition, there were no correlations between the level of TnC, and TOS and OSI. CONCLUSION: Tenascin-C can be used as a biochemical marker in the differential diagnosis of rheumatic and congenital HVD. As the oxidant and antioxidant systems were found to be in equilibrium in rheumatic and congenital HVD, oxidative stress can be thought not to have a marked role in the etiopathogenesis of rheumatic HVD during childhood.

Association between nonalcoholic fatty liver disease and cardiovascular risk in obese children and adolescents.

BACKGROUND: The recent rise in the prevalence of obesity likely explains nonalcoholic fatty liver disease (NAFLD) epidemic worldwide. We evaluated cardiac functions, cardiovascular risk, and associated parameters with grades of NAFLD in obese children. METHODS: Four hundred obese children were enrolled in the study. Obese children with NAFLD were classified in 2 subgroups according to ultrasonographic visualizing. Ninety-three obese children with NAFLD (mean age 11.73 ± 2.72 years in group 2 and 12.69 ± 2.61 years in group 3) were compared with 307 age- and sex-matched non-NAFLD obese children and 150 control subjects. Laboratory parameters were measured during the fasting state. Pulsed and tissue Doppler echocardiography were performed. Intima-media (IMT) and epicardial adipose tissue (EAT) thicknesses were measured. RESULTS: NAFLD groups had a significantly higher body mass index (29.15 ± 3.42 and 30.46 ± 4.60; P < 0.001), total adipose tissue mass (37.95 ± 4.46% and 46.57 ± 6.45%; P < 0.001), higher insulin, alanine aminotransferase, and aspartate aminotransferase levels. Increased end-systolic thickness of the interventricular septum (P < 0.001), larger left ventricular mass (P < 0.003) and index (P < 0.003) were found in NAFLD groups. Children with NAFLD had higher Tei index values. Also, carotid artery IMT and EAT thickness were significantly higher in obese children. Waist and hip circumference, total cholesterol level, total adipose tissue mass, and interventricular septum were statistically different in NAFLD groups. CONCLUSIONS: Children with NAFLD had mildly altered left and right ventricular functions and all obese children had increased IMT and EAT thickness. Also, grade of liver steatosis was positively correlated with total adipose tissue mass and interventricular septum systolic thickness.

Usability of QTc dispersion for the prediction of orthostatic intolerance syndromes.

BACKGROUND: Syncope is defined as transient loss of consciousness and muscle tone, usually of short duration. Noncardiac causes of syncope are classified as orthostatic intolerance syndromes (OIS). QT and QTc (corrected QT) dispersions are the measurements of myocardial instability and show predisposition to arrhythmias. In this study; clinical findings, QT and QTc dispersions of the patients who were diagnosed as OIS were evaluated retrospectively. Also, the aim of the study is to clarify the association of clinical characteristics of unexplained syncope with the outcome of the QT and QTc dispersions in children. METHODS: We designed a retrospective study including 152 children and adolescents who had repeated unexplained syncope or presyncope between June 2002 and August 2010. Head-up Tilt table test (HUTT) were performed for all patients. Control group consisted of 67 healthy children. The QT and QTc dispersions were measured from the 12 ECG leads. RESULTS: Eighty-four (55.2%) patients had positive and 68 (44.8%) had negative response to HUTT. QT and QTc dispersions were significantly higher in HUTT-positive group than in negative (p < 0.01, p < 0.001 respectively). Also, QTc dispersion was significantly higher in both vasovagal syncope and postural orthostatic tachycardia syndrome groups than in HUTT-negative group (p < 0.001, p < 0.05 respectively). Specifity and sensitivity of QTc dispersion for predicting positive HUTT are 76.5% and 59.5% respectively. The positive predictive value of the test calculated as 75.8%. CONCLUSIONS: These results revealed that we can use QTc dispersion measurement as a noninvasive electrocardiographic test to evaluate OIS for predicting positive result before performing HUTT.

[The association between pulmonary arterial hypertension and malnutrition in children with congenital heart diseases with left-to-right shunt: an observational study]. / Sol-sag santli dogustan kalp hastaligi olan çocuklarda pulmoner arteriyel hipertansiyonla malnütrisyonun iliskisi: Gözlemsel bir çalisma.

OBJECTIVE: To evaluate the association between the degree of pulmonary arterial hypertension (PAH) and the level of malnutrition in children with acyanotic congenital heart diseases and left-to-right shunt, and especially to evaluate the development rates of malnutrition in patients with borderline PAH. METHODS: The study was performed with data of 327 patients with acyanotic congenital heart diseases and left-to-right shunt and underwent cardiac catheterization between January 2001-February 2011. The design of the study was retrospective and observational. All patients were evaluated with anthropometric measurements, echocardiography and cardiac catheterization. They were classified according to the mean pulmonary artery pressure and level of malnutrition. Chi-square, ANOVA and Kruskal-Wallis tests were used for statistical analysis. Normally and abnormally distributed data were analyzed with Pearson and Spearman correlation tests respectively. RESULTS: Malnutrition was detected in 94.8% of patients with PAH and 17.2% of no PAH patients according to Gomez classification (p<0.001). In addition, malnutrition was detected in 23.5% (16/68) of borderline PAH group. A negative association was detected between mean pulmonary arterial pressure and body weight for age (Gomez) and z scores of weight (p<0.001 for all). Z scores of weight and height were significantly decreased in patients with PAH in contrast to no PAH group (p<0.001, p<0.01 respectively). There was no statistical difference between no PAH and borderline PAH groups according to Gomez classification and relative body weight formula, however z scores of weight in borderline PAH group were decreased compared with no PAH group (p<0.001). CONCLUSION: A positive association was detected between the degrees of PAH and level of malnutrition in children with a cyanotic congenital heart diseases with left-to-right shunt. Borderline PAH may be a predisposing factor for malnutrition and further studies are needed for this subject.

Evaluation of cardiac functions in term small for gestational age newborns with mild growth retardation: a serial conventional and tissue Doppler imaging echocardiographic study.

BACKGROUND: The aim of this study is to evaluate the cardiac functions of term small for gestational age (SGA) babies with mild growth retardation by echocardiography during the postnatal period. METHODS AND RESULTS: Thirty term SGA (2271±207 g/38-41 weeks (mean 39.5 weeks)) and 30 term AGA (3298±338 g/38-41 weeks (mean 39 weeks)) newborns as the control group, with normal general health status and with no nutritional problems were evaluated at three time points, on the 3rd postnatal day, at the 3rd and the 6th months. In the initial analysis, heart rate, left ventricular end diastolic diameter index (LVEdDI), cardiac index (CI), all E/A, Em/Am and E/Em ratios, pulsed wave Doppler myocardial performance index (MPI), and tissue Doppler imaging MPI values were higher in SGA babies than the control group. In the last analysis, only heart rate, LVEdDI and CI values were different between SGA and control groups. CONCLUSIONS: Systolic and diastolic cardiac dysfunctions were determined in SGA babies with mild growth retardation during the first 6 months of postnatal period. Any disease that affects the hemodynamic stability of these patients during postnatal period may lead to early progressive deterioration in cardiac functions. Furthermore, many of the cardiac functions of these babies have been improved about the 6th month period, and high levels of heart rate and LVEdDI may be suggested as an indicator of cardiac remodeling.