title: Assessment of left atrial mechanical functions and atrial electromechanical delay in Juvenile idiopathic arthritis by tissue Doppler echocardiography.
abstract: BACKGROUND
  Juvenile idiopathic arthritis (JIA) is a systemic chronic inflammatory disease. Studies using tissue Doppler imaging (TDI) for the evaluation of cardiac functions of children with JIA are limited. Thus, this study was conducted to evaluate Left ventricular function, left atrial mechanical functions and atrial electromechanical delay in JIA.
  
  
  METHODS
  This study was carried out as a across sectional study. A total of 34 patients with active JIA and 34 controls were included. Atrial electromechanical delay and left atrial (LA) mechanical functions in addition to systolic and diastolic left ventricular (LV) functions were measured by using conventional echocardiography and TDI. Assessment of disease activity was done using Juvenile arthritis disease activity score (JADAS-27).
  
  
  RESULTS
  JIA patients had abnormal atrial electromechanical coupling as established from prolonged lateral mitral annulus (PA lateral), septal mitral annulus (PA septum), inter-atrial and intra-atrial electromechanical delays compared with healthy controls. Left ventricular filling abnormalities were found characterized by a reduced E/A ratio (1.07 ± 0.56 vs. 1.48 ± 0.16, p = 0.01). E/Em was significantly higher in patients with JIA (7.58 ± 1.79 vs. 4.74 ± 1.45, p = 0.003) denoting impaired diastolic function. Left atrial mechanical functions assessment showed significantly decreased LA passive emptying fraction, increased LA active emptying fraction and LA total emptying volume in JIA patients (p = 0.01, p = 0.01, p = 0.03 respectively).
  
  
  CONCLUSIONS
  Atrial electromechanical coupling intervals, and LA mechanical functions were impaired which can be considered as an early form of subclinical cardiac involvement in JIA patients. Significant diastolic functional abnormalities exist in JIA.
authors.affiliation: Department of Cardiology, Faculty of Medicine, Portsaid University, Portsaid, Egypt.
authors.forename: Azza Z
authors.initials: AZ
authors.lastname: El Eraky
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Portsaid University, Portsaid, Egypt.
authors.forename: Nesrin M
authors.initials: NM
authors.lastname: Handoka
authors.affiliation: Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Suez Canal University, Ismailia, Egypt. mona_ghali@med.suez.edu.eg.
authors.forename: Mona Sayed
authors.initials: MS
authors.lastname: Ghaly
authors.affiliation: Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
authors.forename: Samah Ismail
authors.initials: SI
authors.lastname: Nasef
authors.affiliation: Department of Family Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
authors.forename: Nahed A
authors.initials: NA
authors.lastname: Eldahshan
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Ibrahim
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
authors.forename: Sherein
authors.initials: S
authors.lastname: Shalaby
mesh_terms: D000293:Adolescent; D001145:Arrhythmias, Cardiac / Q000503:physiopathology; D001171:Arthritis, Juvenile / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016279:Atrial Function, Left / Q000502:physiology*; D016022:Case-Control Studies; D002648:Child; D003430:Cross-Sectional Studies; D004452:Echocardiography; D015150:Echocardiography, Doppler; D005260:Female; D006329:Heart Conduction System / Q000502:physiology; D006801:Humans; D008297:Male; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology*
keywords: Atrial mechanical function; Doppler; Echocardiography; Juvenile idiopathic arthritis; Ventricular dysfunction