Evaluation of cardiac functions in cirrhotic children using tissue Doppler imaging

Öz

Background and Aims: Cirrhotic cardiomyopathy is defined as cardiac dysfunction in the presence of cirrhosis. Several studies have been conducted on cirrhotic cardiomyopathy in cirrhotic children. The aim of this study was to investigate cardiac functions and pulmonary complications in children with cirrhosis. Materials and Methods: This study included 52 cirrhotic pediatric patients who were followed up for 2 years from October 2011 to December 2013 at İnönü University, Faculty of Medicine, Department of Pediatric Gastroenterology. In addition, 30 healthy children of similar age and sex were recruited and assessed using conventional echocardiography, color Doppler echocardiography, and tissue Doppler echocardiography. Results: Mean age of the 52 patients in the study group was 6.5±4.6 years; 28 patients were males (53.3%), and 24 were females (47.7%). The mean age of the control group children was 6.88±3.04 years; 16 were males (53.3%), and 14 were females (46.6%). M-mode echocardiographic evaluations of the patients showed increased left ventricular posterior wall thickness compared with that in control children (5.9±1.7 and 5.1±1.8 mm, p=0.03). The mean E/A ratio measured using colored dorsal mitral valve was significantly lower in the patient group than that in the control group (1.46±0.43 and 1.61±0.46, p=0.01). The patient group had longer isovolumic relaxation time (48.5±12.5 and 42.6±11.64 ms, p=0.001) and shorter isovolumetric contraction time (43.6±9.5 and 48.6±11.6 ms, p=0.001) than those in the control group. The myocardial performance index of left ventricle was significantly higher in the patient group (0.57±0.13 and 0.50±0.67, p=0.02) than that in the control group. Eight patients (15%) were diagnosed with hepatopulmonary syndrome. Echocardiographic evaluations of patients with hepatopulmonary syndrome showed that the interventricular septum diastolic thickness (6.9±1.2 and 6.4±1.8 mm, p=0.04) and the deceleration time (154.1±35.6 and 140.4±39.8 ms, p=0.03) were greater than those in the non- hepatopulmonary syndrome patient group. Conclusion: Cirrhotic children have cardiac dysfunction, especially diastolic dysfunction. This effect is more pronounced in patients with hepatopulmonary syndrome. Tissue Doppler echocardiography provides a quantifiable indicator that is useful for the detection and monitoring of disease progression.

Anahtar Kelimeler

• Liver cirrhosis,cardiomyopathy,tissue Doppler imaging,child

Sirozlu çocuklarda kalp fonksiyonlarının doku Doppler görüntüleme ile değerlendirilmesi

Öz

Giriş ve Amaç: Sirotik kardiyomiyopati (CCM) siroz varlığında oluşan kardiyak disfonksiyon olarak tanımlanmaktadır. Pediatrik yaş grubunda sirotik kardiyomiyopati ile ilgili yapılmış çok az sayıda çalışma vardır. Bu çalışmada sirozlu çocuklarda kardiyak fonksiyonlar ile pulmoner komplikasyonları tespit etmek amaçlandı. Gereç ve Yöntem: Bu çalışmada İnönü Üniversitesi Tıp Fakültesi Çocuk Gastroenteroloji Bölümü’nde, Ekim 2011-Aralık 2013 tarihleri arasında retrospektif olarak iki yıllık süreçte izlenen 52 sirozlu çocuk hasta ile yaş ve cinsiyetleri benzer 30 sağlıklı çocuk konvansiyonel, renkli Doppler ve doku Doppler ekokardiyorafik görüntüleme yöntemleriyle değerlendirildi. Bulgular: Çalışmaya alınan 52 olgunun yaş ortalaması 6.5±4.6 yıl, 28’i erkek (%53,3), 24’ü kız (%47,7) idi. Kontrol grubunun yaşlarının ortalaması 6.88±3.04 yıl, 16’sı erkek (%53,3), 14’ü kız (%46,6) olmak üzere toplam 30 idi. Hastaların M-mod değerlendirmelerinde sol ventrikül arka duvarı kontrol grubundan daha kalındı (5.9±1.7 mm ve 5.1±1.8 mm, p:0.03). Renkli Dopplerle mitral kapaktan ölçülen E/A oranı hasta grubunda anlamlı derecede düşüktü (1.46±0.43 ve 1.61±0.46, p: 0.01). Hasta grubu daha uzun izovolümik relaksasyon süresine (48.5±12.5 ms ve 42.6±11.64 ms, p: 0.001) ve daha kısa izovolümetrik kontraksiyon süresine (43.6±9.5 ms ve 48.6±11.6 ms, p: 0.001) sahipti. Hasta grubunda sol ventrikülün miyokard performans indeksi anlamlı olarak yüksekti (0.57±0.13 ve 0.50±0.67, p: 0.02). Hastaların 8 tanesine (%15) hepatopulmoner sendrom tanısı kondu. Hepatopulmoner sendromlu hastaların ekokardiyografik değerlendirilmelerinde, hepatopulmoner sendromu olmayan hasta grubuna göre interventriküler septum diastolik kalınlığı (6,9±1.2 mm ve 6.4±1.8 mm, p: 0.04) ve yavaşlama süresi (154.1± 35.6 ms ve 140.4±39.8 ms, p: 0.03) daha fazla idi. Sonuç: Sirotik çocuklarda başta diyastolik disfonksiyon olmak üzere kardiyak disfonksiyon vardır. hepatopulmoner sendromlu grupta bu etkilenme daha fazladır. Çalışmamız doku Doppler ekokardiyografinin, hastalık progresyonunun saptanması ve izlenmesi için yararlı bir yöntem olduğunu göstermektedir.

Anahtar Kelimeler

• Karaciğer sirozu,kardiyomiyopati,doku Doppler görüntüleme,çocuk

Kaynakça

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