Hayrullah Alp

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.

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.

Normal values of left and right ventricular function measured by M‐mode, pulsed doppler and Doppler tissue imaging in healthy term neonates during a 1‐year period

BACKGROUND The measurements of left and right ventricular functions change after birth due to the influence of several hemodynamic changes upon the immature myocardium. AIM The aim of this study was to investigate the changes in left (LV) and right ventricular (RV) functions of healthy term newborns using conventional and Doppler echocardiography during a 1-year period. SUBJECTS AND METHODS Fifty healthy term newborns were examined prospectively on the first day, 3-4, 6-7, 9-10 and 11-12 months of their lives by M-mode, pulsed Doppler (PD) and Doppler tissue imaging techniques (DTI). PD velocities were obtained from mitral and tricuspid valves while DTI velocities were obtained from the lateral annuluses of atrioventricular valves. RESULTS EF and FS did not change significantly by time. Early (E) flow velocity and early myocardial (Em) velocity were higher than late (A) flow velocity and atrial systolic (Am) velocity for LV, while A and Am velocities were higher than E and Em velocities for RV, respectively during the study period. E, A, Em, Am, Sm velocities and Em/Am ratios increased while E/Em ratios decreased significantly by time (P<0.05) for both ventricle. However, E/A ratios of LV and RV did not change significantly by time. Myocardial performance index (MPI), obtained by PD for RV and by DTI for LV, decreased significantly by time (P<0.05) and these DTI values were higher than PD values during the study period. CONCLUSIONS Due to hemodynamic and maturation change of myocardium PD and DTI velocity changes took place during the first year of life which reflects differences in ventricular adaptation.

Impaired systolic blood dipping and nocturnal hypertension: an independent predictor of carotid intima-media thickness in type 1 diabetic patients.

OBJECTIVE Type 1 diabetes in children predicts a broad range of later health problems including an increased risk of cardiovascular morbidity and mortality. This study aimed to evaluate whether nocturnal hypertension and impaired nocturnal dipping affect atherosclerosis in children and adolescents with type 1 diabetes and to investigate the relationship between atherogenic risk factors and carotid intima-media thickness (CIMT). METHODS One hundred fifty-nine type 1 diabetic patients and 100 healthy controls were included in the study. We investigated metabolic and anthropometric parameters such as body mass index (BMI), waist circumference, fasting glucose and insulin, serum lipids, 24h ambulatory blood pressure monitoring (ABPM), and CIMT and compared these with those in control subjects (CS). RESULTS No difference was found between type 1 diabetic patients and CS in age, weight, waist/hip ratio, triglyceride, HDL-cholesterol level. However in children with type 1 diabetes, total cholesterol (p=0.016),and LDL-cholesterol (p=0.002) levels and CIMT (P<0.001) were greater than those of controls. It was determined that 10% of type 1 diabetic patients had dyslipidemia. In 23.2% of type 1 diabetic patients, ABPM showed arterial hypertension. CIMT was significantly higher in the hypertensive group than in the non-hypertensive group (P=0.003). Twenty-three (14.4%) diabetic patients had nocturnal hypertension. CIMT was significantly greater in the nocturnal hypertensive group (p=0.023). Mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) dipping was significantly different in diabetic patients (P<0.001). CIMT was correlated positively with Hba1c (r=0.220, p=0.037), and negatively with SBP dipping (r=-0.362, p=0.020) in the diabetic patients. In stepwise regression analysis, Hba1c and SBP dipping emerged as a significant predictor of CIMT (β=0.300, p=0.044, β=0.398 p=0.009) contributing to 15.58% of its variability. CONCLUSION These results provide additional evidence for the presence of subclinical cardiovascular disease (CVD) and its relation to hypertension in type 1 diabetic patients. They also indicate a significant relation between nocturnal hypertension, SBP dipping and increased arterial stiffness. It is also important to note that our findings reveal significant relationships between HBA1c cardiovascular changes and underline the importance of glucose control to predict CVD.

Association between vitamin D level and cardiovascular risk in obese children and adolescents

Abstract Background: The aim of our study was to evaluate the associations between vitamin D deficiency, the atherosclerosis and metabolic syndrome. Methods: Two hundred and forty-seven obese children and adolescents, 8–16 years of age (body mass index>95 p) were included in the study. Anthropometric measurements, blood pressure measurements, lipid profile, vitamin D level and carotid intima media thickness (c-IMT) were measured. MS was diagnosed according to IDF criteria. Results: The prevalance of vitamin D deficieny in obese children and adolescent was 46.6%. Low levels of vitamin D were associated with increased carotis intima media thickness and metabolic syndrome (p=0.03, p=0.04, respectively). For clinical cardiovascular risk factors, mutivariable regression analyses showed that low vitamin D level was best predictor of c-IMT. Conclusions: In this study we showed an association between low vitamin D status and atherosclerosis independent of traditional risk factors in obese children and adolescents.

The effect of hypertension and obesity on left ventricular geometry and cardiac functions in children and adolescents.

Objectives: Obesity and hypertension are associated with structural and functional cardiac change in children and adults. The aim of the study is to evaluate the effect of hypertension and obesity on left ventricular geometric patterns and cardiac functions assessed by conventional and Doppler echocardiography. Methods: Four hundred and thirty obese children, aged 6–17 years and 150 age and sex-matched healthy controls, were included in the study. Left ventricular geometry was classified as concentric hypertrophy, eccentric hypertrophy, concentric remodeling and normal geometry. Results: Concentric hypertrophy group had the worst subclinical systolic and diastolic cardiac functions among all left ventricular geometric patterns. BMI and total adipose tissue mass are the predictors of abnormal ventricular geometry. Apart from the increase in carotid intima–media and epicardial adipose tissue thicknesses in different left ventricular geometry patterns, they are not predictable for abnormal geometry. Conclusion: The variety of alterations in cardiac function and morphology that has been observed in obese adults, appears to start earlier in life. Obesity and hypertension were clearly associated with the left ventricular geometry. Also, subclinical systolic and load-depended diastolic dysfunctions can be detected in obese hypertensive children with concentric hypertrophy.

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

Abstract:  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.

Serum Tenascin-C: A Novel Biomarker for Diagnosis and Predicting Prognosis of Rheumatic Carditis?

BACKGROUND Tenascin-C (TnC) is an extracellular matrix glycoprotein that has a major role in tissue remodeling. OBJECTIVE To evaluate the serum TnC level in acute rheumatic fever (ARF) and chronic rheumatic heart disease (CRHD) during childhood. METHODS Twenty-five patients with ARF, 25 patients with CRHD and 20 control subjects were included in the study. The TnC levels were analyzed using the enzyme-linked immunosorbent assay method in the ARF group. RESULTS The TnC levels were lower in the acute carditis group compared with the control group (p < 0.001). The cut-off level was estimated as 2.08 ng/ml for diagnosing carditis with 93.3% sensitivity and 95% specificity. On second analysis, prominent decrease was detected in valve insufficiency patients with markedly elevated TnC levels. In the CRHD group, TnC level was significantly lower in cases with severe valve insufficiency (p < 0.001). CONCLUSIONS Serum TnC level can be used as a new biochemical marker for diagnosis and predicting the prognosis of rheumatic carditis.

Prevalence of and risk factors for early postoperative arrhythmia in children after cardiac surgery

The aims of this study were to (i) evaluate postoperative arrhythmias following congenital heart surgery, on 12‐lead electrocardiography and Holter monitoring; and (ii) analyze the association between the type of repair and postoperative arrhythmia.

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

Abstract 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.