2nd Department of Pediatrics, Iuliu Hațieganu University of Medicine and Pharmacy, 3-5 Crișan Street, Cluj-Napoca, Romania.
Eur J Pediatr. 2024 Nov;183(11):4789-4797. doi: 10.1007/s00431-024-05746-6. Epub 2024 Sep 4.
Liver cirrhosis is a significant global health concern, and cirrhotic cardiomyopathy (CCM) is a notable complication affecting both adults and children. While CCM is well-studied in adults, understanding its manifestation and diagnostic criteria in pediatric patients remains a challenge. This review explores the evidence for structural and functional cardiac alterations in children with liver cirrhosis. Structural abnormalities, including increased left ventricular mass index (LVMI) and altered left ventricular wall thickness ratios, are prevalent in pediatric CCM. These abnormalities persist even after liver transplantation, highlighting the systemic impact of liver disease. Evidence suggests that altered systolic and diastolic function, as well as electrocardiographic abnormalities such as prolonged QT intervals, are common in pediatric CCM. Blood biomarkers, including brain natriuretic peptide (BNP) and troponin levels, offer insights into cardiac function in pediatric cirrhotic patients. Elevated BNP levels correlate with adverse outcomes, indicating its potential as a prognostic marker. However, further research is needed to elucidate the diagnostic utility of these biomarkers in pediatric CCM.
This review provides estimates of the standardized mean difference among selected cardiac parameters in children with and without cirrhosis. Tailored diagnostic criteria and comprehensive assessment methods will be essential for accurate diagnosis and effective management of pediatric CCM.
• CCM adds to the burden of care of patients with cirrhosis. • Diagnostic criteria for adults are evolving, but there are no specific criteria for pediatric CCM.
• Cardiac function in children with cirrhosis indicates some parameters not considered in adults are altered. • Effect size estimations for certain parameters provide a guideline for future research into pediatric CCM.
探讨儿童肝硬化患者的心脏结构和功能改变。
我们检索了 Medline、Embase 和 Cochrane 图书馆，以确定截至 2023 年 6 月发表的关于儿童肝硬化中心脏结构和功能改变的研究。
共纳入 15 项研究，涉及 115 名儿童。研究结果表明，左心室质量指数（LVMI）增加和左心室壁厚度比改变等结构异常在小儿 CCM 中很常见。这些异常在肝移植后仍然存在，突出了肝脏疾病的全身性影响。证据表明，改变的收缩和舒张功能以及心电图异常，如 QT 间期延长，在小儿 CCM 中很常见。脑钠肽（BNP）和肌钙蛋白等血液生物标志物可提供小儿肝硬化患者心脏功能的信息。BNP 水平升高与不良结局相关，表明其可能作为预后标志物。然而，需要进一步的研究来阐明这些生物标志物在小儿 CCM 中的诊断效用。
本综述提供了小儿肝硬化和非肝硬化患者选定心脏参数的标准化均数差估计值。针对小儿 CCM 的特定诊断标准和综合评估方法对于准确诊断和有效管理至关重要。
