Effects of childhood obesity on myocardial performance, autonomic and conduction properties of the heart.

BACKGROUND: Childhood obesity tends to persist into adulthood and associated with increase in developing ischemic and non-ischemic cardiovascular diseases. We aimed to evaluate the effect of obesity on cardiac functions, atrial electromechanical coupling, and heart rate response, which are considered to be predictors of atrial fibrillation and sudden cardiac arrest. METHODS: Study population included 52 obese children and 52 healthy controls. We performed 12-lead electrocardiography, echocardiographic examination, and treadmill exercise testing. Mitral, septal, and tricuspid segments were analysed by tissue Doppler imaging. RESULTS: Myocardial performance index (p = 0.011, p < 0.001, and p = 0.001, respectively) was higher and E'/A' ratio (p = 0.011, p < 0.001, and p < 0.001, respectively) was lower in obese group than controls. Atrial electromechanical coupling was longer in the obese group at all three segments (p < 0.001, p = 0.009, and p = 0.04, respectively). They had significantly longer interatrial (p < 0.001) and intra-atrial (p = 0.003) electromechanical conduction delay. While chronotropic index was similar between two groups, heart rate reserve was lower in obese children than controls (p = 0.043). The 1st- and 2nd-minute heart rate recovery indices of the obese group were lower compared to controls (p < 0.001 and p = 0.03, respectively). Body mass index was positively correlated with intra- and inter-atrial conduction times, whereas it was negatively correlated with heart rate recovery indices. CONCLUSION: We showed a deterioration in the diastolic function, atrial conduction, and heart rate response properties in children with obesity. Given the prognostic importance of these parameters, obese patients are might be at risk for atrial fibrillation and severe dysrhythmias from a young age.

Evaluation of blood pressure responses to treadmill exercise test in normotensive children of hypertensive parents.

BACKGROUND: Hypertension is a progressive disease with a prehypertensive phase. The most important feature of this period is the abnormal cardiovascular reactivity to various stressors. In our study, we focused on normotensive children of hypertensive parents, a special group that is at risk. METHODS: We evaluated the children according to age, studying whether they showed higher cardiovascular reactivity at different steps of an exercise test and during a recovery period than their counterparts with a negative history. A total of 110 normotensive children who were between the ages of 6 and 18 years were enrolled into the study. Sixty-two children whose parent(s) had a history of hypertension formed the study group while 48 without this history formed the control group. An exercise test was performed according to the Bruce protocol. Maximal systolic blood pressures and systolic blood pressures were taken while the participants were at rest; during phases 2 and 3; and also in the first, third, and sixth minutes of the recovery period. RESULTS: Measurements were significantly higher in the study group (p < 0.05). In the group of children between the ages of 6 and 10 years, cardiovascular responses were similar. Children older than 10 years, however, had significantly higher blood pressure levels than those in the control group. The children who were at risk of hypertension showed more exaggerated cardiovascular responses during the exercise test and recovery period. This response was particularly evident for those children 10 years of age and older. CONCLUSIONS: Our study indicates that treadmill exercise is a safe and effective investigational method which can be used to identify children who are at risk for development of hypertension before this condition becomes clinically evident.

Early myocardial changes in normotensive children of hypertensive parents: a tissue Doppler study.

The aim of this study was to examine early left ventricular systolic and diastolic changes using tissue Doppler imaging (TDI) in normotensive children of hypertensive parents (NCHP), a risk group for cardiovascular diseases. Ninety-two children characterized as NCHP (age range: 6-18 years) and 90 age-, gender-, height-, weight-, and body mass index-matched children characterized as normotensive children of normotensive parents (NCNP) were included in the study. Left ventricular diastolic parameters were assessed using transmitral flow pulse wave Doppler echocardiography and mitral septal and lateral annular TDI. Left ventricular systolic and diastolic function was evaluated globally using the TDI-derived myocardial performance index (MPI'). Mean systolic, diastolic, and average blood pressure values were found to be higher in the NCHP group than in the NCNP group. Echocardiographic parameters in the NCHP group showed statistically significant differences, including increased interventricular septum end-diastolic wall thickness (p = 0.039), left ventricular end-diastolic posterior wall thickness (p = 0.011), relative wall thickness (p = 0.013), and transmitral flow A velocity (p = 0.003); parameters determined by TDI included a prolonged isovolumetric relaxation time (p < 0.001) and isovolumetric contraction time (p = 0.002), shortened ejection time (p = 0.001), and increased MPI' (p < 0.001) in the NCHP group. Early alterations in myocardial function, indicated by increased MPI' values, had a positive correlation with systolic blood pressure and myocardial thickness. Conversely, they were negatively correlated with the ejection fraction and E/A ratio, which decreases with diastolic dysfunction. The MPI' is considered a repeatable, non-invasive, and low-cost assessment method that can surpass conventional methods in the detection of early left ventricular systolic and diastolic functional changes in the subclinical period of hypertension in children with familial risk.

Acute rheumatic fever: a single center experience with 193 clinical cases.

BACKGROUND: Acute rheumatic fever is an inflammatory disease that develops via an auto-immune mechanism following group A beta hemolytic streptococcal tonsillopharyngitis. The aim of this study was to describe the clinical presentation of and cardiac involvement in acute rheumatic fever. METHODS: The medical records of acute rheumatic fever patients admitted to the Pediatric Cardiology Unit between January 2001 and January 2013 were reviewed. The patients were divided into two groups: 53 patients admitted during January 2001-January 2007 were designated as group 1, and 140 patients admitted during January 2007-January 2013 were designated as group 2. RESULTS: A total of 193 patients were evaluated, including 53 in group 1 and 140 in group 2. There was no statistically significant difference in age, gender and latent period between the two groups. There was, however, a statistically significant difference between the annual number of cases (P=0.001). Moreover, 35 (66%) patients in group 1 and 89 (64%) patients in group 2 were admitted during the spring or winter. The most common finding, as the major criteria in the current study, was concurrent carditis and arthritis. The most common minor finding was the presence of increased acute-phase reactants. We noted a statistically significant difference between the two groups in terms of valvular involvement. Group 2 had significantly higher frequencies of isolated aortic and mitral regurgitation than group 1, but the composite frequency of these was lower. CONCLUSIONS: Acute rheumatic fever continues to be prevalent in Turkey despite the country's socioeconomic improvements. We conclude that echocardiography should be performed on all of the patients with suspected acute rheumatic fever because it markedly increases the detection of carditis.

Uric Acid Levels in Normotensive Children of Hypertensive Parents.

This study evaluated uric acid concentrations in normotensive children of parents with hypertension. Eighty normotensive children from families with and without a history of essential hypertension were included. Concentrations of lipid parameters and uric acid were compared. Demographic and anthropometric characteristics were similar in the groups. Systolic and diastolic blood pressure were higher in the normotensive children of parents with hypertension without statistically significant difference (P > 0.05). Uric acid concentrations were higher in the normotensive children of parents with hypertension (4.61 versus 3.57 mg/dL, P < 0.01). Total cholesterol and triglyceride concentrations were similar in the two groups. Systolic and diastolic blood pressure were significantly higher in control children aged >10 years (P < 0.01). Uric acid levels were significantly higher in all children with more pronounced difference after age 10 of years (P < 0.001). Positive correlations were found between the level of serum uric acid and age, body weight, body mass index, and systolic and diastolic blood pressure in the normotensive children of parents. The higher uric acid levels in the normotensive children of hypertensive parents suggest that uric acid may be a predeterminant of hypertension. Monitoring of uric acid levels in these children may allow for prevention or earlier treatment of future hypertension.

Carotid intima-media thickness and elastic properties of aortas in normotensive children of hypertensive parents.

A significant correlation between hypertension history and high blood pressure has been observed with regard to age, race and gender. Investigating carotid intima-media thickness and aortic stiffness prior to the development of hypertension in children of hypertensive parents enabled us to evaluate these patients for subclinical atherosclerosis. We compared carotid intima-media thickness, aortic strain, distensibility, stiffness indices and elastic modulus in 67 normotensive children whose parents had a diagnosis of essential hypertension and 39 normotensive children with no parental history of hypertension. Although there were no significant differences between the two groups in terms of systolic blood pressure, diastolic blood pressure, average blood pressure and pulse pressure (P>0.05), systolic blood pressures were higher among patients 15 years and older in the study group. No significant differences were noted between the control and study groups regarding interventricular septal thickness, left-ventricular posterior wall thickness, left-ventricular systolic and diastolic diameter and aortic annulus diameter (P>0.05). The left atrium diameter was larger in the study group compared with that in the control group, mainly because of the values of the 15-year-old and older children (P=0.01). The mean, maximum and minimum values of carotid intima-media thickness were significantly different in the study group compared with the control group among all age groups (P<0.001, P<0.001, P=0.006, respectively). Aortic systolic and diastolic diameters were larger in normotensive children of hypertensive parents compared with the control group (P=0.014, P=0.001, respectively). Although there were no differences between the study and control groups regarding aortic strain, aortic distensibility, elastic modulus and stiffness indices (P>0.05), aortic distensibility was lower, and aortic stiffness indices were higher among children 15 years and older in the study group. An increase in the carotid intima-media thickness in all age groups and a decrease in aortic elastic properties in 15-year-old and older children of hypertensive parents may indicate subclinical atherosclerosis in these apparently healthy children.

Homocysteine levels in normotensive children of hypertensive parents.

OBJECTIVE: There are several studies showing an association between an increase in the plasma levels of homocysteine and the pathogenesis of hypertension. In this study, we assessed normotensive children of hypertensive adult parents to determine whether there is any change in homocysteine levels prior to the onset of hypertension. METHODS: A total of 79 normotensive children of essential hypertensive parents who were followed-up at the cardiology department and 72 healthy children of normotensive parents who presented to the department of pediatrics at our clinic with complaints such as nonspecific chest pain and innocent murmur were included in the study. The participants' complete blood count and low-density lipoprotein, high-density lipoprotein, triglyceride, total cholesterol, folic acid, vitamin B12, and homocysteine levels were noted. RESULTS: No statistically significant differences were noted between the two groups in terms of age, gender, height, weight, body mass index, or levels of fasting lipids, folic acid, and vitamin B12 (p>0.05). Although the mean systolic and diastolic blood pressures were within the normal limits in both groups, they were significantly higher in children with a family history of hypertension than in controls (p<0.05). Similarly, homocysteine levels of children with a family history of hypertension were significantly higher than those of controls (p<0.01). CONCLUSION: Homocysteine levels of normotensive children of hypertensive parents are elevated before they develop hypertension. Homocysteine levels may be predictive of the subsequent development of hypertension in normotensive children of hypertensive parents.

Circulating matrix metalloproteinases and tissue inhibitors of metalloproteinases levels in pediatric patients with congenital heart disease: Relationship to cardiac functions.

OBJECTIVE: The pathological effects of matrix metalloproteinases and their tissue inhibitors in cardiovascular diseases are of considerable interest. In our study, we aimed to determine and evaluate the potential significance of circulating matrix metalloproteinases-2 and 9, tissue inhibitors of matrix metalloproteinases-1 and 2 levels in four patient subgroup of pediatric cardiology field and expose pathophysiologic differences between these groups. METHODS: Eighty-seven patients with the diagnosis of congenital heart disease and 47 healthy controls were enrolled in the study. The study group was stratified to 4 subgroups; 14 patients with right ventricular volume overload, 30 patients with left ventricular volume overload, 19 patients with left to right shunt who developed pulmonary hypertension and 24 patients with cyanotic congenital heart disease. For evaluation of the relationships between serum matrix metalloproteinases and their tissue inhibitors levels with cardiac structures and functions; complete blood count, arterial oxygen saturation, detailed echocardiographic measurements (including tissue Doppler) in all patients and hemodynamic parameters of the patients who went to cardiac catheterization were recorded. Serum matrix metalloproteinase levels were determined by ELISA test. Statistical evaluations were performed with SPSS 16.0. For parameters showing normal distribution, comparisons were made with t-test and ANOVA test. However, for parameters without normal distribution, groups were compared with Mann-Whitney U test and Kruskal-Wallis test. RESULTS: We demonstrated that serum tissue inhibitors of matrix metalloproteinases-1 levels of patients with pulmonary hypertension secondary to congenital heart diseases were significantly higher than the patients with left to right shunt without pulmonary hypertension and controls (p<0.01). Although serum matrix metalloproteinases and their tissue inhibitors levels in patients with cyanotic congenital heart diseases and patients with right or left ventricular volume overload were found to be altered when compared with controls but not significant. CONCLUSION: Our data may suggest the possible role of matrix metalloproteinases and their tissue inhibitors on myocardial remodeling in congenital heart defects and especially in patients who developed pulmonary hypertension.

Total anomalous systemic venous drainage with heterotaxia syndrome: a rare case.

Total anomalous systemic venous return is a very rare anomaly, where vena cava inferior, vena cava superior, and coronary sinus drain into left atrium. Two-day-old male baby was admitted with cyanosis and tachypnea after the birth. Left atrial isomerism with anomalous systemic venous drainage was found on echocardiographic examination. We present an unusual case of total anomalous systemic venous drainage in to the left atrium.