الفهرس 
DILATED CARDIOMYOPATHYOnly 14 pages are availabe for public view
 |  | from | 177 |  |  |
| | | from | 177 | | |
Abstract
T
he aim of the current study was to assess the effect of some micronutrient status (Cupper, Zinc and serum ferritin) on myocardial functions in pediatric patients with dilated cardiomyopathy.
The study was a cross sectional study that was carried out in Pediatric Cardiology Outpatient Clinic in conjunction with Echocardiography Lab, Children’s Hospital, Ain Shams University within the period between December 2017 till August 2021 and was conducted on thirty pediatric patients with chronic heart failure due to dilated cardiomyopathy.
In the current study median age of participants was 5 years with range between (0.75 – 15 years), median weight was 15kg with range (7 – 60kg), mean Height was 100.60 cm and mean BMI was 18.49. Regarding Ross classification of the patients 20% (6 patients) were classified as Class I, 50% (15 patients) were classified as Class II and 30% (9 patients) were classified as Class III.
All patients had stable vital data with mean systolic BP 93mmHg, mean diastolic BP 61mmHg, mean HR was 109 and mean O2 sat 95%.
Regarding pharmacotherapy 83.3% (n=25) of patients were on Digoxin therapy, 93.3% (n=28) were on Captopril therapy, 86.7% (n=26) were on Spironolactone therapy, All cases were prescribed Furosemide with a mean dose 1.58 mg/kg/day, while 50% of the patients were on Aspirin and L Carnitine was taken by 63.3 % of patients.
On assessment of cardiac functions mean LV EDD was 4.71mm with (range 3.1 – 6.3), with a median Z Score of +4.08.
As for the Systolic functions mean EF was 37.17% with (range 13 – 52) and mean FS 18.07% while Global longitudinal strain a mean -12.5 with (range -19.9 – 11.5).
Regarding Diastolic functions, median E’ was 0.08mm, mean A’ was 0.06mm, median E’/A’ was 1.25 and mean TIE index was 0.61 with range (0.35 – 1.14).
On assessment of trace elements, median Serum cupper was 30.23 umol/l with (range 20 – 251). 23.3% of patients had normal Serum cupper while 76.7% had high Serum cupper. Median Serum zinc was 77mcg/dl with (range 30 – 190), 21 patients (70%) had normal Serum zinc, 7 patients (23.3%) showed low Serum zinc and 2 patients (6.7%) had high Serum zinc. Median Serum ferritin was 50 ng/ml with (range 7.2 – 257), 24 patients (80%) with normal Serum ferritin, 4 patients (13.3% ) showed low Serum ferritin, 2 patients (6.7%) had high Serum ferritin.
No significant correlation was found between trace elements levels and clinical parameters of the patients except of a positive correlation between Serum zinc and HR (P=0.048).
However, on correlating echocardiographic parameters to different trace elements levels statically a negative correlation was found between serum cupper and EF (%)(P=0.045) and between cu levels with A’ velocity (p=0.036) denoting inverse relationship between serum cupper and both systolic and diastolic functions. Comparing patients with normal and high serum cupper level, patients with high cupper level had sign worse ross classification and increase dose of spironolactone (p=0.037) decreased EF(%) (P=0.030) and decreased FS (%) (P=0.041).
A positive correlation was found between serum level of ferritin and LVEDD (p=0.036) denoting correlation between Fe level and LV dimensions. S. Ferritin correlated +ve with PAP (p=0.003), however Z score (p=0.023) was significant increase in patients with high serum ferritin in those patients.
Serum Zinc didn’t correlate with any of the echocardiographic parameters.
Finally, on correlating trace elements status to medication used significant correlation was found between serum ferritin & L-Carnitine (p=.038) as well as between cupper and spironolactone(p=0.037).
CONCLUSION
• Cupper, zinc and serum ferritin abnormalities are not uncommon in pediatric patients with dilated cardiomyopathy.
• Elevated serum cupper seems to be related to worse systolic and diastolic functions.
• Abnormalities in serum zinc do not seem to affect cardiac functions in patients with dilated cardiomyopathy.
• Elevated serum ferritin is related to increased LV dimensions but not related to the decreased systolic or diastolic functions.
• Serum ferritin is related also to estimated PAP in patients with DCM.
RECOMMENDATIONS
1- Larger sample size of patients should be studied to allow better comparisons between patients subgroups and highlight subtle differences.
2- Regular measurements and follow up of trace elements in patients with dilated cardiomyopathy can uncover hidden relationships between trace elements abnormalities and cardiac status
3- Dietary factors should be taken in consideration as well as other confounding factors to better highlight correlations between cardiac chambers dimensions, functions and trace elements status.
4- Advanced imaging techniques can be used to better visualize affection of systolic and diastolic functions abnormalities in relation to trace elements abnormalities
5- Future researches can identify whether trace elements abnormalities are a cause or a result of dilated cardiomyopathy and deceased cardiac functions.