title: Investigation of cardiomyopathy in children with cirrhotic and noncirrhotic portal hypertension.
abstract: BACKGROUND
  Cirrhotic cardiomyopathy (CCMP) is a functional disorder characterized by electrophysiological disturbances, and diastolic and/or systolic dysfunction in patients with liver disease. This disorder is a well-defined entity in adults, but pediatric data are limited. The aim of the study was to determine the incidence, features, and risk factors of CCMP in children with portal hypertension (PHT).
  
  
  METHODS
  This study included 50 children with cirrhotic PHT (40/50) and noncirrhotic PHT (10/50). Fifty healthy children were also selected for the control group. Electrocardiography and echocardiography were used to evaluate cardiac functions. Corrected QT (QTc) ≥ 0.45 was accepted as prolonged on electrocardiography. The study group was divided into 3 groups: cirrhotic, noncirrhotic, and control. Then, the CCMP group was created according to the diagnostic criteria. Latent CCMP was diagnosed in the presence of prolonged-QTc along with a minor criterion (tachycardia). Manifest CCMP was diagnosed in the presence of at least 2 major criteria (prolonged-QTc along with abnormal echocardiographic findings). Moreover, in this study, the risk factors for CCMP were investigated.
  
  
  RESULTS
  The CCMP group included 10 cases (20%). Nine of these cases had latent CCMP (18%), and the remaining one (2%) had manifest CCMP. All of the cases with CCMP had cirrhosis and ascites. None of the patients with CCMP had severe cardiac symptoms, but they were already using some cardioprotective drugs such as propanolol and spironolactone. As risk factors for CCMP, pediatric end-stage liver disease scores, Child-Pugh scores, and ascites grades were found to be significant for the determination of CCMP. The most important risk factor was ascites severity (P = 0.001, odds ratio 9.4).
  
  
  CONCLUSIONS
  Approximately 20% of children with PHT have CCMP. A detailed cardiac examination should be carried out periodically in children with cirrhotic PHT, especially in the presence of ascites and high Child-Pugh score.
authors.affiliation: *Sifa Faculty of Medicine, Pediatric Gastroenterology and Hepatology, Sifa University, Izmir †Istanbul Faculty of Medicine, Pediatric Gastroenterology and Hepatology, Istanbul University, Istanbul ‡Istanbul Faculty of Medicine, Pediatric Cardiology, Istanbul University, Istanbul §Bezm-i Alem Faculty of Medicine, Pediatric Gastroenterology and Hepatology, Bezm-i Alem University, Istanbul ||Kocaeli Faculty of Medicine, Pediatric Gastroenterology and Hepatology, Kocaeli University, Izmit/Kocaeli ¶Selcuk Faculty of Medicine, Pediatric Gastroenterology and Hepatology, Selcuk University, Konya, Turkey.
authors.forename: Coskun
authors.initials: C
authors.lastname: Celtik
authors.forename: Ozlem
authors.initials: O
authors.lastname: Durmaz
authors.forename: Naci
authors.initials: N
authors.lastname: Oner
authors.forename: Taner
authors.initials: T
authors.lastname: Yavuz
authors.forename: Selim
authors.initials: S
authors.lastname: Gökce
authors.forename: Aysen
authors.initials: A
authors.lastname: Aydogan
authors.forename: Kemal
authors.initials: K
authors.lastname: Nisli
authors.forename: H Haldun
authors.initials: HH
authors.lastname: Emiroglu
authors.forename: Rukiye E
authors.initials: RE
authors.lastname: Ömeroglu
authors.forename: Semra
authors.initials: S
authors.lastname: Sökücü
mesh_terms: D000293:Adolescent; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001201:Ascites / Q000209:etiology; D001794:Blood Pressure; D009202:Cardiomyopathies / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004232:Diuretics / Q000627:therapeutic use; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications* / Q000188:drug therapy; D015994:Incidence; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D011433:Propranolol / Q000627:therapeutic use; D012307:Risk Factors; D012720:Severity of Illness Index; D013148:Spironolactone / Q000627:therapeutic use; D013610:Tachycardia / Q000209:etiology
chemical_list: D000959:Antihypertensive Agents; D004232:Diuretics; D013148:Spironolactone; D011433:Propranolol