Giacchi Valentina, Rotolo Novella, Amato Barbara, Di Dio Giovanna, Betta Pasqua, La Rosa Mario, Leonardi Salvatore, Sciacca Pietro
Department of Medical and Paediatric Science, University of Catania, Catania, Italy.
Department of Medical and Paediatric Science, University of Catania, Catania, Italy.
Heart Lung Circ. 2015 Oct;24(10):1002-10. doi: 10.1016/j.hlc.2015.03.006. Epub 2015 Mar 24.
Cardiovascular involvement in Cystic Fibrosis (CF) is a not rare condition, although the prevalence of subclinical pulmonary hypertension (PH) and cardiac dysfunction is not known in the early stages of CF progression. The aim of our study was to assess cardiac involvement in children and adults affected by cystic fibrosis compared with healthy subjects of same age using echocardiography.
Fifty-five patients, 25 adults and 30 children completed the study. We assessed FEV1 (Forced Expiratory Volume in one second), and carried out colour Doppler-echocardiography evaluating ejection fraction (EF) measurement of left ventricle, tricuspid annular plane systolic excursion (TAPSE) of right ventricle and pulmonary artery pressure (PAP). We compared the auxological, respiratory and cardiologic data with those of 16 adults and 34 children of the same age.
We discovered significantly different values of PAP between patients and controls in both children (p = 0.0001, r=- 0.62) and adults (p=0.0001, r=- 0.63), whereas the EF and TAPSE showed significantly different values in only adults (p=0.0023 and p=0.0194 respectively). We found in both children and adults with CF an inverse correlation between PAP and FEV1 (p=0.000, p=0.001), Erythrocyte Sedimentation Rate (ESR) and FEV 1 (p=0.015, r=- 0.43; p=0.009, r=- 0.51), and highly sensitive C-reactive protein (hs-CRP) and FEV 1 (p=0.007, r=- 0.48; p=0.001, r=- 0.60). In adults we also detected direct correlation between PAP and hs-CRP (p=0.008, r=0.51) and PAP and ESR (p=0.009, r=0.51).
In paediatric-aged CF patients there are already early signs of potential heart impairment, represented by an increase of pulmonary blood pressure, and in adult age the systolic function of right ventricle may be impaired. We hypothesise that such cardiac impairments may gradually arise due to preceding chronic inflammation related to prior degeneration of lung function and thus it is very important to keep patients clinically stable and address chronic inflammation as early as possible in the progression of CF.
囊性纤维化（CF）患者出现心血管受累并不罕见，尽管在CF进展的早期阶段，亚临床肺动脉高压（PH）和心脏功能障碍的患病率尚不清楚。我们研究的目的是通过超声心动图评估与同龄健康受试者相比，受囊性纤维化影响的儿童和成人的心脏受累情况。
55名患者（25名成人和30名儿童）完成了该研究。我们评估了第一秒用力呼气量（FEV1），并进行了彩色多普勒超声心动图检查，测量左心室射血分数（EF）、右心室三尖瓣环平面收缩期位移（TAPSE）和肺动脉压（PAP）。我们将人体测量学、呼吸和心脏学数据与16名同龄成人和34名同龄儿童的数据进行了比较。
我们发现，儿童（p = 0.0001，r = -0.62）和成人（p = 0.0001，r = -0.63）患者与对照组之间的PAP值存在显著差异，而EF和TAPSE仅在成人中显示出显著差异（分别为p = 0.0023和p = 0.0194）。我们发现，CF儿童和成人的PAP与FEV1之间均呈负相关（p = 0.000，p = 0.001），红细胞沉降率（ESR）与FEV1之间呈负相关（p = 0.015，r = -0.43；p = 0.009，r = -0.51），高敏C反应蛋白（hs-CRP）与FEV1之间呈负相关（p = 0.007，r = -0.48；p = 0.001，r = -0.60）。在成人中，我们还检测到PAP与hs-CRP之间呈正相关（p = 0.008，r = 0.51）以及PAP与ESR之间呈正相关（p = 0.009，r = 0.51）。
在儿童期CF患者中，已经有潜在心脏损害的早期迹象，表现为肺血压升高，而在成年期，右心室的收缩功能可能受损。我们推测，这种心脏损害可能由于先前与肺功能退化相关的慢性炎症逐渐出现，因此在CF进展过程中，保持患者临床稳定并尽早处理慢性炎症非常重要。
