Unveiling subclinical myocardial dysfunction in pediatric Helicobacter pylori infection via speckle tracking echocardiography

Öz

Background and Aims: Helicobacter pylori is among the most prevalent infectious agents globally. Recent evidence has highlighted its potential impact beyond the gastrointestinal tract, including possible effects on the cardiovascular system. This study aimed to evaluate myocardial function in children with Helicobacter pylori infection using advanced echocardiographic modalities, particularly two-dimensional speckle tracking echocardiography. Materials and Methods: A total of 54 children diagnosed with Helicobacter pylori infection (mean age: 14 ± 3.1 years) and 37 age-matched healthy controls (mean age: 13.6 ± 2.2 years) were enrolled. Conventional echocardiography, tissue Doppler imaging, and two-dimensional speckle tracking echocardiography were performed to assess left ventricular function. Results: No significant differences were found in traditional echocardiographic parameters between the groups. However, the myocardial performance index measured via tissue Doppler imaging was significantly higher, and mitral S', A', and E'/A' values were significantly lower in the Helicobacter pylori group (p < 0.05). Furthermore, both global longitudinal strain and circumferential strain values obtained from two-dimensional speckle tracking echocardiography were significantly reduced in the patient group (global longitudinal strain: –18.1 ± 0.8 vs. –19.6 ± 1.1; circumferential strain: –19.2 ± 1.2 vs. –21.2 ± 1.0; p < 0.001). Conclusion: Helicobacter pylori infection in children is associated with subclinical alterations in myocardial function, which can be detected using two-dimensional speckle tracking echocardiography and tissue Doppler imaging -derived myocardial performance index. These findings underscore the importance of cardiac follow-up in children diagnosed with Helicobacter pylori infection.

Anahtar Kelimeler

• Helicobacter pylori
• myocardial dysfunction
• subclinical cardiomyopathy
• tissue Doppler imaging
• strain echocardiography

Helicobacter pylori enfeksiyonu olan çocuklarda subklinik miyokardiyal disfonksiyonun ortaya çıkarılması: Speckle tracking ekokardiyografi ile değerlendirme

Öz

Giriş ve Amaç: Helicobacter pylori, dünya çapında en yaygın enfeksiyon etkenlerinden biridir. Son bulgular, gastrointestinal sistemin ötesinde, kardiyovasküler sistem üzerindeki olası etkileri de dahil olmak üzere potansiyel etkisini vurgulamaktadır. Bu çalışma, Helicobacter pylori enfeksiyonu olan çocuklarda miyokardiyal fonksiyonu, özellikle iki boyutlu speckle tracking ekokardiyografi olmak üzere gelişmiş ekokardiyografik yöntemler kullanarak değerlendirmeyi amaçlamaktadır. Gereç ve Yöntem: Helicobacter pylori enfeksiyonu tanısı almış toplam 54 çocuk (ortalama yaş: 14 ± 3.1 yıl) ve yaşları eşleştirilmiş 37 sağlıklı kontrol (ortalama yaş: 13.6 ± 2.2 yıl) çalışmaya dahil edildi. Sol ventrikül fonksiyonunu değerlendirmek için konvansiyonel ekokardiyografi, doku Doppler görüntüleme ve iki boyutlu speckle tracking ekokardiyografi uygulandı. Bulgular: Gruplar arasında geleneksel ekokardiyografik parametrelerde anlamlı bir fark bulunmadı. Ancak, doku Doppler görüntüleme ile ölçülen miyokardiyal performans indeksi Helicobacter pylori grubunda anlamlı derecede yüksek, mitral S', A' ve E'/A' değerleri ise anlamlı derecede düşüktü (p < 0.05). Ayrıca, iki boyutlu speckle tracking ekokardiyografi ile elde edilen hem global longitudinal strain hem de circumferential strain değerleri hasta grubunda istatiksel anlamlı düşük saptandı (global longitudinal strain: –18.1 ± 0.8 vs. –19.6 ± 1.1; circumferential strain: –19.2 ± 1.2 vs. –21.2 ± 1.0; p < 0.001). Sonuç: Çocuklarda Helicobacter pylori enfeksiyonu, iki boyutlu speckle tracking ekokardiyografi ve doku Doppler görüntüleme türevli miyokardiyal performans indeksi kullanılarak tespit edilebilen miyokardiyal fonksiyonda subklinik değişikliklerle ilişkilidir. Bu bulgular, Helicobacter pylori enfeksiyonu tanısı alan çocuklarda kardiyak takibin önemini vurgulamaktadır.

Anahtar Kelimeler

• Helicobacter pylori
• miyokardiyal disfonksiyon
• subklinik kardiyomiyopati
• doku Doppler görüntüleme
• strain ekokardiyografi

Kaynakça

1. 1. Suerbaum S, Michetti P. Helicobacter pylori infection. N Engl J Med 2002;347(15):1175-86. doi: 10.1056/NEJMra020542.
2. 2. Prelipcean CC, Mihai C, Gogălniceanu P, et al. Extra gastric manifestations of Helicobacter pylori infection. Rev Med Chir Soc Med Nat Iasi 2007;111(3):575-83.
3. 3. Danesh J, Youngman L, Clark S, et al. Helicobacter pylori infection and early onset myocardial infarction: case-control and sibling pairs study. BMJ 1999; 319(7218):1157-62. doi: 10.1136/bmj.319.7218.1157.
4. 4. Gunn M, Stephens JC, Thompson JR, Rathbone BJ, Samani NJ. Significant association of cagA positive Helicobacter pylori strains with risk of premature myocardial infarction. Heart. 2000;84(3):267-71. doi: 10.1136/heart.84.3.267.
5. 5. Ikeda A, Iso H, Sasazuki S, et al; JPHC Study Group. The combination of Helicobacter pylori- and cytotoxin-associated gene-A seropositivity about the risk of myocardial infarction in middle-aged Japanese: The Japan Public Health Center-based study. Atherosclerosis 2013;230(1):67-72. doi: 10.1016/j.atherosclerosis.
6. 6. Choi JM, Lim SH, Han YM, et al. Association between Helicobacter pylori infection and arterial stiffness: Results from a large cross-sectional study. PLoS One 2019;14(8):e0221643. doi: 10.1371/journal.pone.0221643.
7. 7. Simon OA, Görbe A, Hegyi P, et al. Helicobacter pylori Infection Is Associated With Carotid Intima and Media Thickening: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2022; 11(3):e022919. doi:10.1161/JAHA.121.022919.
8. 8. Jones NL, Koletzko S, Goodman K, e; ESPGHAN, NASPGHAN. Joint ESPGHAN/NASPGHAN Guidelines for the Management of Helicobacter pylori in Children and Adolescents (Update 2016). J Pediatr Gastroenterol Nutr. 2017;64(6):991-1003. doi: 10.1097/MPG.0000000000001594.

9. 9. Dixon MF, Genta RM, Yardley JH, Correa P, et al. Classification and grading of gastritis: The updated Sydney system. Am J Surg Pathol 1996;20(10):1161-81. doi: 10.1097/00000478-199610000-00001.
10. 10. Cheitlin MD, Armstrong WF, Aurigemma GP, et al; ACC; AHA; ASE. ACC/AHA/ASE 2003 Guideline Update for the Clinical Application of Echocardiography: summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography). J Am Soc Echocardiogr. 2003;16(10):1091-110. doi: 10.1016/S0894-7317(03)00685-0.
11. 11. Kadappu KK, Thomas L. Tissue Doppler imaging in echocardiography: value and limitations. Heart Lung Circ 2015; 24(3):224-33. doi: 10.1016/j.hlc.2014.10.003.
12. 12. Mondillo S, Galderisi M, Mele D, et al; Echocardiography Study Group Of The Italian Society Of Cardiology (Rome, Italy). Speckle-tracking echocardiography: a new technique for assessing myocardial function. J Ultrasound Med. 2011;30(1):71-83. doi: 10.7863/jum.2011.30.1.71.
13. 13. Roth GA, Mensah GA, Fuster V. The global burden of cardiovascular diseases and risk factors: 2020 and Beyond. J Am Coll Cardiol 2020; 76(25):2980-1. doi: 10.1016/j.jacc.2020.11.021.
14. 14. Gasbarrini A, Franceschi F, Armuzzi A, et al. Extradigestive manifestations of Helicobacter pylori gastric infection. Gut 1999;45 Suppl 1(Suppl 1):I9-I12. doi: 10.1136/gut.45.2008.i9.
15. 15. Wewer V, Kalach N. Helicobacter pylori infection in pediatrics. Helicobacter 2003:8 Suppl 1:61-7. doi: 10.1046/j.1523-5378.2003.00165.x.
16. 16. Vijayvergiya R, Vadivelu R. Role of Helicobacter pylori infection in the pathogenesis of atherosclerosis. World J Cardiol 2015;7(3):134-43. doi: 10.4330/wjc.v7.i3.134.
17. 17. Oshima T, Ozono R, Yano Y, et al. Association of Helicobacter pylori infection with systemic inflammation and endothelial dysfunction in healthy male subjects. J Am Coll Cardiol 2005;45(8):1219-22. doi: 10.1016/j.jacc.2005.01.019.
18. 18. Kjeldsen J, Rasmussen M, Schaffalitzky de Muckadell OB, Kronborg O, Junker P. Collagen metabolites in the peripheral and splanchnic circulation of patients with Crohn's disease. Scand J Gastroenterol 2001;36(11):1193-7. doi: 10.1080/00365520152584833.
19. 19. Ciarambino T, Crispino P, Minervini G, Giordano M. Role of Helicobacter pylori Infection in Pathogenesis, Evolution, and Complication of atherosclerotic plaque. Biomedicines 2024;12(2):400. doi: 10.3390/biomedicines12020400.
20. 20. Aramouni K, Assaf RK, Azar M, et al. Infection with Helicobacter pylori may predispose to atherosclerosis: role of inflammation and thickening of intima-media of carotid arteries. Front Pharmacol 2023;14:1285754. doi: 10.3389/fphar.2023.1285754.
21. 21. Vijayvergiya R, Vadivelu R. Role of Helicobacter pylori infection in the pathogenesis of atherosclerosis. World J Cardiol 2015;7(3):134-43. doi: 10.4330/wjc.v7.i3.134.
22. 22. He C, Yang Z, Lu NH. Helicobacter pylori infection and diabetes: is it a myth or fact? World J Gastroenterol 2014;20(16):4607-17. doi: 10.3748/wjg.v20.i16.4607.
23. 23. Franceschi F, Brisinda D, Buccelletti F, et al. Prevalence of virulent Helicobacter pylori strains in patients affected by idiopathic dysrhythmias. Intern Emerg Med. 2013;8(4):333-7. doi:10.1007/s11739-011-0621-8.
24. 24. El Amrousy D, Elshehaby W, Elsharaby R, et al. Myocardial function using two dimension speckle-tracking echocardiography in children with celiac disease. Eur J Pediatr. 2024;183(2):947-54. doi: 10.1007/s00431-023-05343-z.
25. 25. Cenk S, Aylin DB, Fatma EA, et al. Assessment of left ventricular function by strain-strain rate echocardiography in patients with celiac disease. Turk J Med Sci 2014;44(2):173-7. doi: 10.3906/sag-1210-21.
26. 26. Deveci M, Uncuoğlu Aydoğan A, Altun G, et al. Left ventricular mechanics are affected in children with celiac disease: A study based on two-dimensional speckle tracking echocardiography. Echocardiography 2017;34(9):1339-46. doi: 10.1111/echo.13624.
27. 27. Erolu E, Polat E. Cardiac functions and aortic elasticity in children with inflammatory bowel disease: effect of age at disease onset. Cardiol Young 2020;30(3):313-7. doi: 10.1017/S1047951119002932.
28. 28. Hensel KO, Abellan-Schneyder FE, Wilke L, et al. Speckle Tracking Stress Echocardiography Uncovers Early Subclinical Cardiac Involvement in Pediatric Patients with Inflammatory Bowel Diseases. Sci Rep 2017;7(1):2966. doi: 10.1038/s41598-017-03255-1.
29. 29. Akiya A, Takahashi K, Akimoto S, et al. Novel Findings of Early Cardiac Dysfunction in Patients With Childhood-Onset Inflammatory Bowel Disease Using Layer-Specific Strain Analysis. Inflamm Bowel Dis 2023;29(10):1546-54. doi: 10.1093/ibd/izad031.
30. 30. Mandoli GE, Cameli M, Pastore MC, et al; Working Group of Echocardiography of Italian Society of Cardiology (SIC). Speckle tracking echocardiography in early disease stages: a therapy modifier? J Cardiovasc Med (Hagerstown). 2023;24(Suppl 1):e55-e66. doi: 10.2459/JCM.0000000000001422.