Subclinical Myocardial Dysfunction in Pediatric and Adolescent Celiac Disease Patients: A Systematic Review and Meta-Analysis.

This is the first systematic review and meta-analysis investigating early myocardial dysfunction in children/adolescents with celiac disease and the effect of a gluten-free diet by comparing early echocardiographic markers between patients and healthy individuals and between compliant and non-compliant celiac disease patients (based on serum antibody titers). A systematic literature search was conducted across major electronic databases, with data collection extending up to 3 March 2024. In total, 15 studies with 916 children/adolescent patients with celiac disease and 569 healthy individuals were included. Our results showed a trend toward reduced myocardial function in all echocardiographic parameters (conventional and advanced), with statistical significance in fractional shortening and the myocardial performance index. However, these parameters did not differ significantly after adherence to a gluten-free diet. Therefore, we recommend that an examination of the cardiovascular system should be incorporated into the routine investigations of children with celiac disease in order to detect early subclinical myocardial dysfunction based on echocardiography. Although the results of our meta-analysis indicate that the myocardial performance index may serve as a useful, non-invasive marker for assessing myocardial function in children and adolescents with celiac disease, further research is needed in order to confirm its reliability and clinical applicability in this population. The improvement of echocardiographic parameters after long-term compliance to a gluten-free diet is yet to be evaluated.