Sevim Karaarslan

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.

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.

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.

Serum ischemia-modified albumin level and its association with cardiovascular risk factors in obese children and adolescents

Abstract Background: Serum ischemia modified albumin (IMA) levels have been previously studied and found to correlate with some anthropometric and laboratory measurements in adult obesity. IMA had not been studied in obese children and adolescents. Objective: The aim of the study is to analyze serum IMA levels and to evaluate their correlation with cardiovascular risk factors in obese children and adolescents with and without metabolic syndrome (MS). Subjects and methods: Sixty-one obese children/adolescents and 33 healthy children were included in the study. The obese group was divided into four subgroups, including MS (n=25), non-MS (n=36), liver steatosis (n=19) and non-liver steatosis (n=42) groups. Blood was collected to analyze biochemical parameters and IMA. Epicardial adipose tissue thickness was measured with echocardiography, and liver steotosis was determined with ultrasonography for each subject. Results: Body mass index (BMI), waist circumferences (WC), left ventricular mass (LVM) and epicardial adipose tissue (EAT) thickness were significantly higher in obese subjects. Serum IMA levels were significantly higher in the metabolic syndrome (MS) and hepatosteotosis groups. Additionally, LVM and EAT thickness were found to be correlated with serum IMA levels in these groups. Conclusions: Our study suggests that serum IMA levels may be used to predict cardiovascular risk in obese children with MS and hepatosteotosis. This may be related to the duration of obesity in childhood ending in adulthood.

Evaluation of Serum Ischemia Modified Albumin Levels in Acute Rheumatic Fever Before and After Therapy

ObjectiveTo investigate ischemia modified albumin (IMA) levels in children with acute rheumatic fever (ARF) before and after therapy and compare them with those of controls.MethodsTwenty seven patients with ARF and 18 healthy, age and sex matched children were included in the study. The diagnosis of ARF was established according to the modified Jones criteria. Follow-up studies were made when acute phase reactants [erythrocyte sedimentation rate (ESR), C-reactive protein (CRP)] levels returned normal. IMA levels were measured using the rapid and colorimetric method with the albumin cobalt binding test.ResultsIMA levels were significantly higher in ARF group (p < 0.001) compared with controls at the time on admission. IMA (absorbance units) was measured as 0.41 ± 0.10 in the control group, 0.55 (0.44–1.13) in the study group before treatment and 0.48 ± 0.12 in the study group after treatment. After treatment, statistically important decrements were determined in the levels of ESR (p<0.001), CRP (p<0.001) and IMA (p<0.01). There was no significant difference for IMA levels between after treatment and control group. IMA levels at the time on admission correlated positively with ESR (r = 0.605, p < 0.01) and CRP (r = 0.543, p < 0.01).ConclusionsThe present study shows that increased serum IMA levels in patients with ARF at the time of diagnosis is a sign of increased inflammation. Thus, serum IMA levels may be used as a follow-up marker like CRP and ESR for evaluating the efficacy of treatment in ARF.

Is myocardial performance index useful in differential diagnosis of moderate and severe hypoxic–ischaemic encephalopathy? A serial Doppler echocardiographic evaluation

INTRODUCTION The aim of this study was to investigate the importance of myocardial performance index as an additive criterion to Sarnat criteria in differential diagnosis of newborn babies with moderate and severe hypoxic-ischaemic encephalopathy. METHODS Our study group included 50 healthy term newborn babies and 20 newborn babies with hypoxic-ischaemic encephalopathy. The 20 newborn babies with hypoxic-ischaemic encephalopathy were scored using Sarnat grades. Left and right ventricular functions were determined on the first day and thereafter in the 1, 3-4, 6-7, and 11-12 months of life by M-Mode and pulsed Doppler. RESULTS Myocardial performance indexes of the left ventricle were significantly higher in the severe hypoxic-ischaemic encephalopathy group than in the control group during the first, second, and third analyses (p = 0.01, p = 0.02, p = 0.02, respectively) and only during the first analysis (p = 0.01) in the moderate hypoxic-ischaemic encephalopathy group. In addition, the myocardial performance indexes of the right ventricle were significantly higher during the first, second, and third analyses in both severe and moderate hypoxic-ischaemic encephalopathy groups than in the control group (p = 0.01, all). Hypoxia-induced alterations last longer in the right ventricle than in the left ventricle in the moderate group, as during the second and third analyses myocardial performance index continues to be higher than the control group. CONCLUSION Myocardial performance indexes for the left and right ventricles were significantly higher in both severe and moderate hypoxic-ischaemic encephalopathy groups than in the control group during the first analysis, and myocardial performance index greater than or equal to 0.5 can be used in order to distinguish moderate and severe hypoxic-ischaemic encephalopathy babies according to Sarnat grades as a discriminative additive criterion.

Electrocardiographic ST elevation (mosque sign) without myocardial ischemia in an infant with tuberous sclerosis

Rhabdomyomas, the most common primary cardiac tumors seen in infants and children, are often associated with tuberous sclerosis. However, these cardiac rhabdomyomas may cause hemodynamic disturbances and arrhythmias. In the present case, we demonstrated an infant with electrocardiographic ST elevation suggesting myocardial ischemia associated with multiple cardiac rhabdomyomas.

Supraventricular tachycardia due to blunt chest trauma in an adolescent.

Blunt chest trauma and its associated complications represent a rare cause of cardiac arrest in a healthy child, although an increasing number of these events have been reported. Victims are most often diagnosed in ventricular fibrillation or tachycardia. However, cardiac conduction abnormalities are also reported. In this report, a healthy adolescent with supraventricular tachycardia associated with blunt chest trauma due to a football is presented. This is the first report in the literature of atrial arrhythmia in these cases with chest trauma.