الفهرس 
Non Alcoholic Fatty Liver DiseaseOnly 14 pages are availabe for public view
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Abstract
Background: Pediatric non-alcoholic fatty liver disease (NAFLD) has emerged as a growing global health problem worldwide and is considered the most common cause of chronic liver disease in pediatrics. Both NAFLD and heart failure are obesityrelated conditions with high cardiovascular morbidity and mortality that have reached epidemic proportions. Speckle Tracking Echocardiography (STE) is an echocardiographic imaging technique that provides both quantitative and qualitative information regarding tissue deformation and motion. The aim of this study: was to evaluate subclinical myocardial dysfunction using the 3-dimensional STE in a group of overweight/obese children and adolescents with NAFLD and to correlate the 3-dimensional strain with clinical, metabolic, cardiac marker (troponin I) and other echocardiographic parameters. Patients and methods: This prospective case-control study was carried out upon 80 children (40 obese cases with NAFLD, 20 obese cases without NAFLD and 20 healthy controls). Diagnosis of NAFLD was based on the finding of hepatic steatosis detected and graded by abdominal ultrasonography. These children underwent full clinical examination, some lab investigations including troponin I and Echocardiography including 3D STE. Results: - Using tissue Doppler imaging (TDI) mean values of myocardial performance index (MPI) was significantly higher in patients compared to controls, whereas other parameter showed no significant difference. - Using 3D STE mean values of longitudinal, circumferential, radial and area strains (LS, CS, RS and AS) were significantly lower in patients compared to controls, whereas mean values of LV mass were significantly higher in patients compared to the controls. - Left ventricular mass by echo showed significant increase as the hepatic steatosis was advancing in severity. Conclusion: Patients with NAFLD have evidence of subclinical myocardial dysfunction using 3D- STE. Although the 3D-STE provides new insight into alterations in LV structure and function related to insulin resistance (IR) in NAFLD patients, it cannot be used for differentiation of steatosis grading. Recommendations: from this study we could recommend further larger prospective studies searching for NAFLD-related subclinical myocardial dysfunction by 3D STE to contribute for a better understanding of the pathogenesis and management of this problem. NAFLD children should be screened by 3D STE for subclinical myocardial dysfunction.