Ertürk Levent

Follow-up of cardiac abnormalities in female adolescents with anorexia nervosa after refeeding.

Objectives — Anorexia nervosa is a life-threatening eating disorder, with significant risk for sudden death due to severe cardiac complications. The aim of this prospective study was to evaluate the cardiac abnormalities in female adolescents with anorexia nervosa and to examine the long-term results and reversibility of the detected cardiac abnormalities. Methods — We prospectively studied eleven female adolescents (13.5-17 years old) with anorexia nervosa diagnosed according to DSM IV criteria. On admission they were all on a weight-losing course with a mean body mass index of 13.71 ± 1.54 (11.38-17.05) kg/m2. The mean follow-up duration was 2.45 ± 1.17 (1-4.5) years. All patients reached normal weight after treatment. The control group was composed of 12 healthy, age-matched, adolescent girls of normal weight. The patients with anorexia nervosa and the control group underwent a complete clinical examination, electrocardiographic and echocardiographic evaluations.These evaluations were repeated one year after refeeding. Results — Patients with anorexia nervosa had a lower heart rate and blood pressure than the control group and they increased to normal levels as found in the control group after refeeding. QT and QTc were significantly longer and R wave amplitudes in V6 were significantly lower in the patients with anorexia nervosa than in the control group. QT and QTc dispersions were significantly greater in anorexia nervosa patients compared to the control group. Left ventricular mass and left ventricular mass index were significantly lower in the anorexia nervosa group. One year after refeeding, there was a significant decrease in QT, QTc, QTd and QTcd. Although in anorexia nervosa patients, R wave amplitudes in V6 increased after refeeding; they did not reach the levels found in the control group. Control echocardiograms of anorexia nervosa patients after refeeding showed an increase in LV diameters and cardiac mass.There was a strong correlation between QT dispersion and left ventricular mass index. Conclusions — The adolescent girls with anorexia nervosa had significant structural and functional cardiac abnormalities in comparison to the control group. All these abnormalities were reversible except low R wave amplitude in V6.

Stiffness of the abdominal aorta in obese children.

Obesity is pathogenically related to clinical and subclinical disorders that contribute to the development of atherosclerotic plaques and their complications leading to onset of cardiovascular events. Arterial stiffness may be an indicator of early vascular changes signaling the development of vascular disease. The purpose of this study was to assess the stiffness of the abdominal aorta using transthoracic echocardiography in normotensive obese and hypertensive obese pediatric patients and a control group. The study group consisted of 25 healthy children (M/F: 13/12) as a control group (Group I), 25 normotensive obese children (M/F: 13/12) (Group II) and 25 hypertensive obese children (M/F: 14/11) (Group III). The mean ages were 12.1 +/- 1.8, 11.9 +/- 1.5 and 12.4 +/- 1.4 years, respectively. Aortic strain (S), pressure strain elastic modulus (Ep) and normalized Ep (Ep*) measurements were significantly different in the hypertensive obese group, and cholesterol levels and body mass index were higher in this group. These findings may be important in determining the relationship between obesity and cardiovascular risk factors at pediatric age.

Childhood cirrhosis, hepatopulmonary syndrome and liver transplantation

Abstract:  Objectives:  The hepatopulmonary syndrome (HPS) is characterized as a triad: liver disease, intrapulmonary vascular dilatatiton, and arterial hypoxemia. The aim of this study is to analyze outcome of children with HPS in liver transplant era.

The relation of arterial stiffness with intrauterine growth retardation.

Background:  Much epidemiological evidence has linked low birthweight with late cardiovascular risk. Intrauterine growth retardation (IUGR) is associated with the increased risk of cardiovascular disease in adult life; it is unclear whether the relationship is present at younger ages. We evaluated whether abdominal aortic stiffness was altered in patients with IUGR (born at term with birthweight small for gestational age) in younger ages.

Impact of liver transplantation on rate‐corrected QT interval and myocardial function in children with chronic liver disease*

Abstract:  Prolonged QTc interval (>440 ms) is a common abnormality in adult patients with CLD and has been reported to predict patient survival. In this study, 88 children who underwent evaluation for LT, including a 12‐lead electrocardiogram and echocardiogram included to determine the frequency of QTc prolongation and related factors in children with CLD and the effect of LT on these factors. Sixty‐nine healthy, age‐ and sex‐matched children served as controls. QTc interval was prolonged in 40 CLD patients (45.4%). It was found to be related to PELD score and presence of portal hypertension. Mean QTc was higher in patients who died prior to LT than in the survivors without LT. Mortality risk was increased 3.66‐fold in patients with prolonged QTc (p = 0.001, 95% CI: 2–7.2). Cox regression analysis showed that only PELD score was an independent predictor of survival (p = 0.001, β = −0.41, 95% CI: 5.58–1.82). Five of 48 transplanted children died within three months post‐transplant; QTc was not related to post‐transplant survival (p = 0.27). QTc normalized in 63.8% patients after LT. After LT, LAD, LVEF, and LVPWT decreased. In conclusion, QTc prolongation is common in children with CLD and associated with high mortality. It may be useful for assessment of the severity of CLD and for the timing for transplantation.

Frequency of acquired von Willebrand's disease in children with congenital heart disease.

Objective — Bleeding tendency of paediatric patients with congenital heart disease has been well recognized.The underlying pathologies of this bleeding tendency have been studied extensively and many causes were identified. Among these causes, we aimed to find the frequency of acquired von Willebrand’s disease (AvWD) in children with congenital heart disease. Material and methods — Forty-nine children with different forms of congenital cardiopathies who were assigned for surgery, are included in the study. Serum von Willebrand factor antigen level as well as ristocetin cofactor agglutination ratios were determined preoperatively and at one week and 6 months postoperatively. Results — Six patients (12.2%) were found to have AvWD. However, we found no relation between bleeding tendency and AvWD status. Conclusion — Although frequency of von Willebrand factor deficiency is higher in children with congenital heart disease than in the normal population, this condition does not result in adverse clinical outcomes like increased bleeding tendency during operation.

Allelic frequency of the MCP-1 promoter −2518 polymorphism in the Turkish population and in Turkish patients with juvenile rheumatoid arthritis

Although genetic and environmental factors contribute to the pathogenesis of juvenile rheumathoid arthritis (JRA), the etiology and pathogenesis remain controversial. The objective of this study was to investigate genotypic and allelic frequencies of monocyte chemoattractant protein-1 (MCP-1) gene −2518 (G/A) polymorphism in the healthy Turkish population and patients with JRA. Genomic DNA was collected from 66 JRA patients and 150 healthy individuals. To evaluate the association of the −2518 (G/A) MCP-1 gene polymorphism with the outcome of JRA, we analyzed the types of JRA and the score on the childhood health assessment questionnaire (C-HAQ score). In the healthy Turkish population, the frequencies of A and G alleles were 71 and 29%, respectively. No significant difference was observed between the JRA patients and healthy subjects in the distribution allelic and genotypic frequencies of the −2518 (G/A) MCP-1 gene polymorphism (p>0.05). However, the AG genotype was found to be higher and the AA genotype was found to be lower in the patients with systemic type JRA compared to those with the other types of JRA (p=0.019). When the JRA patients were evaluated according to the C-HAQ score, we found that the −2518 (G/A) MCP-1 gene polymorphism did not relate the prognosis (p>0.05). AG genotype was found to be higher in the systemic type of JRA. The results indicate that MCP-1 gene polymorphism might slightly associate with patients with systemic JRA. Further studies are needed to elucidate the role of this polymorphism in the pathogenesis of JRA in various populations because this polymorphism has a functional significance and an ethnic difference.

Time domain heart rate variability analysis in patients with thalassaemia major

Objective — Cardiac complication is one of the major causes of death in patients with thalassaemia major. Heart rate variability is a non-invasive index of neuronal modulation of heart rate. In this study, autonomic functions of the heart in a preclinical stage of heart disease were evaluated in 48 thalassaemic patients with time domain heart rate variability analysis; the control group consisted of 45 healthy subjects. Methods and results — Mean RR time in the study and control group was 0.73 ± 0.1, and 0.82 ± 0.1 ms respectively (p < 0.001). In the study group; SDNN, SDNN-i, SDANN-i, RMSSD, and PNN50 were found to be 167.4 ± 86.2 ms, 153.9 ± 108.1 ms, 111.4 ± 60.4 ms, 108.9 ± 86.7 ms, and 14.5 ± 13.4%, respectively.Time domain parameters were significantly lower in the study group than the control group (p < 0.001).There was a significant positive correlation between the mean RR time and SDNN, SDNN-i, SDANN-i, RMSSD, and PNN50 (for the RMSSD p < 0.05, r = 0.31; for the others p = 0.000, and r values were 0.65, 0.65, 0.38, 0.37 for the SDNN, SDNN-i, SDANN-i, and PNN50, respectively). Conclusion — The analysis of heart rate variability might be helpful to detect cardiac complications in the preclinical stage of the cardiac involvement.

Chitotriosidase as a possible marker of clinically evidenced atherosclerosis in dyslipidemic children.

Abstract A correlation has been clearly shown between inflammation markers and subclinical atherosclerosis markers in the early stages of atherogenesis in subjects with familial hypercholesterolemia (FH). The aim of this study was to investigate potential inflammation markers in the diagnosis of atherosclerosis in children with FH. A total of 48 dyslipidemic children and 24 healthy age-matched control subjects were taken into study. Inflammation and macrophage activation markers (hsCRP, myeloperoxidase, chitotriosidase, YKL-40, TNF-α, IL-6, IL-18, MMP-1 and MMP-9) and lipid parameters of all patients were measured. Carotid intima-media thickness (cIMT) and flow-mediated dilation (FMD) levels were determined. Our data suggested that clinically evidenced (by cIMT and FMD levels) atherosclerosis starts in the early ages in hypercholesterolemic children. Higher cholesterol levels strongly correlated with macrophage activation markers (ChT, YKL-40 and myeloperoxidase). ChT and YKL-40 seem to be the more predictable markers of atherosclerosis even in early ages (<6 years old) than other classical inflammation markers such as hs-CRP, IL-6 and TNF-α.

Cardiovascular Consequences of Bronchopulmonary Dysplasia in Prematurely Born Preschool Children

Background: A limited number of studies have reported various short-term cardiovascular changes in bronchopulmonary dysplasia (BPD) patients in the postsurfactant era. Little is known about the course of these changes in children with BPD. Objectives: It was the aim of this study to investigate cardiovascular consequences of BPD at preschool ages and to find out possible risk factors related to cardiovascular sequelae. Methods: Prematurely born children with (n = 21) and without BPD (n = 20) were evaluated with conventional and myocardial tissue Doppler echocardiography at the age of 2-4 years. Results: BPD patients had a decreased pulmonary artery acceleration time and higher left and right ventricular myocardial performance indexes, consistent with higher pulmonary pressures and impaired biventricular systolic and diastolic functions at preschool ages. Low birth weight, disease severity and postnatal cumulative steroid dose were related to these changes. Conclusion: Negative effects of BPD on global cardiac performances of both ventricles and pulmonary arterial pressure persist up to preschool ages.