Child – ABC CARDIOL

ABCIC

Editorial

Chemotherapy-Induced Cardiotoxicity in the Pediatric Population: What Are the Unique Aspects of Cardiovascular Imaging Follow-Up?

Jéssica Laureano Martins et al. Maria do Carmo Menezes Bezerra Duarte Fabiana Gomes Aragão Magalhães Feitosa Maria Verônica Câmara dos Santos

Special considerations for the pediatric population^,

The pediatric perspective in cardio-oncology presents particular challenges, given that cardiotoxicity related to cancer treatment is not limited to an acute event, but represents a dynamic process that can interfere with myocardial growth and maturation over time. The vulnerability of the developing heart, associated with early exposure to potentially cardiotoxic therapies, confers a prolonged risk of progressive myocardial dysfunction. In this context, the use of more sensitive, reproducible, and integrated cardiovascular imaging strategies becomes fundamental. The multimodal approach, with emphasis on echocardiography (and cardiac magnetic resonance imaging in selected situations), increases diagnostic accuracy and contributes to better risk stratification. Additionally, structured longitudinal follow-up, with interpretation based on clinical individualization, is essential for adequate follow-up of these patients.

Finally, the incorporation of genetic, clinical, and therapeutic factors into risk models, coupled with continuous imaging monitoring, represents a promising perspective for precision medicine, with the goal of reducing cardiovascular morbidity and mortality and improving the quality of life of pediatric cancer survivors.

[…]

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ABC

Original Article

Evaluation of Pulse Wave Velocity using Transthoracic Echocardiography in Children with Bicuspid Aortic Valve

Kerem Ertaş et al. Özlem Gül

Abstract

Background

Increased aortic stiffness in patients with bicuspid aortic valve (BAV) may significantly affect morbidity and mortality.

Objective

We aimed to evaluate aortic elasticity properties and the usability of the new technique by measuring pulse wave velocity (PWV) with a transthoracic echocardiography device in patients with BAV.

Methods

Fifty patients with BAV and 50 healthy children with similar demographic characteristics were included in this study. Patients with BAV were grouped according to fused cusp morphology. Valve function was normal or near normal in the patients with BAV included in the study. All patients’ left ventricular function, aortic root diameter, and aortic elasticity characteristics were evaluated. A p-value <0.05 was considered significant.

Results

PWV was significantly higher in the BAV group (p=0.000). Aortic elasticity parameters obtained from ascending aorta diameters were similar between the groups. Ascending aorta diameters were significantly higher in the BAV group. There was a correlation between PWV, ascending aortic diameter, vena contracta in aortic regurgitation, and peak aortic velocity. PWV inter- and intraobserver reliability alpha values were 0.92 and 0.84, respectively.

Conclusions

In the pediatric BAV group with normal or near-normal valve function, although aortic elasticity parameters were normal with conventional measurements based on ascending aorta diameters, PWV measurements with the same device were significantly higher without the need for an additional apparatus or program, and aortic stiffness increased in the BAV group. PWV measurement by echocardiography is a reliable and reproducible technique.

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IJCS

Editorial

The Relationship Between Obesity and the Risk of Systemic Arterial Hypertension in Children and Adolescents: Lessons Learned

John Jairo Araujo

One out of five children around the world is overweight or obese. This is shown in the meta-analysis published by Zhang X et al. in 2024, which included 2,033 studies from 154 different countries or regions. Although the prevalence of childhood obesity varies between global regions, it is evident that its incidence is growing significantly. According to the latest United Nations International Children’s Emergency Fund (UNICEF) and World Bank estimates, 33.6% of children and adolescents 5-19 years old are affected by overweight or obesity, as are 8% of children under the age of five. Recently, Muyulema SL et al. published the results of global childhood overweight and obesity trends over the last 20 years. In this study, they analyzed 194 countries around the world, showing that the global prevalence of childhood overweight and obesity increased from 5.4% to 5.7% between 2000 and 2022.

Inflammation, Metabolic Syndrome and Systemic Hypertension: “a dangerous and synergistic triad”: Metabolic Syndrome (MS) has been well defined in adults, and includes various conditions like Systemic Arterial Hypertension (SAH), elevated fasting blood sugar levels (greater than 100 mg/dl) or type 2 diabetes mellitus, low HDL cholesterol levels (less than 40 mg/dl in men or 50 mg/dl in women), high triglyceride concentrations (greater than 150 mg/dl), and a waist circumference greater than 101 cm (men) or 90 cm (women). It is not clearly defined in children, due to the imprecision of the various factors that compose it and the changes in different stages of life. However, risk factors like obesity, increased waist circumference (increased visceral fat), insulin resistance, and, in certain cases, lipid profile abnormalities, are compatible with MS, especially in children over the age of 10.

[…]

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ABCIC

Editorial

Emerging Topics in Pediatric Echocardiography: A Review by the Associate Editors of the Pediatric Section

Karen Saori Shiraishi Sawamura et al. Márcio Miranda Brito

Ventricular septal morphology and cardiac development

Anderson et al. convened international experts to propose a unified morphofunctional classification of ventricular septal defects, with emphasis on embryological features and ventriculoarterial connections. The authors critically examine the nomenclature currently in use and suggest that defect descriptions should encompass both their anatomical location and the borders involved. This approach integrates principles of cardiac development and allows, for example, differentiation between perimembranous defects in hearts with double outlet right ventricle and those with concordant ventriculoarterial connections. The article provides a clear and didactic review of cardiac embryological development, supported by illustrations that facilitate a more precise diagnostic and surgical approach.

[…]

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ABCIC

Review Article

My Approach To Echocardiographic Evaluation in Pediatric Patients with Sickle Cell Disease

Viviane Thome Gonçalves Dias et al. Mirela Frederico de Almeida

Abstract

Sickle cell disease (SCD) is the most prevalent hereditary genetic disorder worldwide, and cardiovascular alterations are the main cause of death among patients with this disease.

Therefore, the early identification of markers of sickle cell cardiomyopathy using echocardiographic parameters (Central Illustration) is essential for the appropriate management of the cardiovascular condition in these patients.

This review provides a comprehensive overview of the use of echocardiography in pediatric patients with SCD, highlighting the main characteristics of the condition and the importance of regular follow-up.

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IJCS

Original Article

Assessment of Overweight/Obesity and Elevation of Blood Pressure in Schools in Rural and Urban Area in the Backlands of Bahia

Andressa Lopes et al. Ana Luisa Vaz Valois Hanna Louise de Almeida Lisboa Alexvon Nunes Gomes … Renata Lago Camilla Almeida Menezes Ana Marice Teixeira Ladeia

Abstract

Background:

Childhood and adolescent obesity has been increasing, particularly in countries with greater social vulnerability. Given this context, assessing schoolchildren from Bahia’s backlands — a region known for its low-income population — is essential.

Objective:

To assess the frequency of overweight and obesity and their association with high blood pressure (BP) in children from urban and rural areas in four municipalities in the backlands of Bahia.

Methods:

This study is part of a project evaluating the impact of a school meal intervention on the health of children and adolescents in Bahia’s backlands. A subset of children aged five to ten from public schools in both rural and urban areas of four cities in Bahia’s backlands was selected through random and proportional sampling. The participants had their weight, height, waist circumference and BP measured using standardized protocols. The Body Mass Index (BMI) was expressed as a z-score to determine nutritional status. The Student’s t-test and Chi-square tests were used, with 5% statistical significance.

Results:

The sample consisted of 461 students, 264 (57.3%) from urban areas and 238 (51.6%) males. The prevalence of overweight was 27.9%, and that of increased waist circumference was 7.4%. High BP or hypertension had a prevalence of 8%. A significant difference (p = 0.049) was observed between rural and urban areas in relation to the increased waist circumference.

Conclusion:

The research revealed a high frequency of overweight, increased waist circumference and systemic BP in students, mainly those from urban areas.

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IJCS

Original Article

Body Profile Impact on Blood Pressure and Lipid Profile in Rural and Urban Schoolchildren of a Brazilian Semiarid Region in The State of Bahia

Lívia Assis Mendonça et al. Alexvon Gomes Renata Lago Camilla Menezes … Sérgio Roberto Lemos de Carvalho Ana Marice Teixeira Ladeia

Abstract

Background:

The present study describes the prevalence of excess weight, obesity, and high blood pressure (BP) in children from a Brazilian semiarid region (Sertão) and its association with lipid profile and area of residence.

Objective:

To describe the prevalence of excess weight, obesity, and high BP in children, as well as the association between these variables, lipid profile, and area of residence.

Methods:

Thi work is a cross-sectional study conducted with schoolchildren, aged 6 to 10 years, from three municipalities in the countryside of Brazil. Weight, height, waist circumference (WC), and BP, together with the analysis of lipid markers, were assessed. Z-scores (BMI-Age) were used to determine the anthropometric classification. Total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglycerides (TG) were meseared with eight hours of fasting. The Student’s t-test and the Mann-Whitney test were aplied. Perceptual maps were constructed through multiple correspondence analysis. A p-value<0.05 was considered statistically significant. The Institution's Ethics Committee approved this study (CAAE: 35038914.3.0000.5544).

Results:

Among 138 schoolchildren in this study, 76 (55.07%) were female and 81 (58.7%) were from urban areas. Twenty-one children (15.2%) were overweight, and 44 (31.9%) had a family history of obesity. Children from rural areas showed higher levels of TC (p = 0.041) and systolic BP (p = 0.028). The correlation between excess weight and a family history of obesity (p = 0.029), TG (p = 0.003), TG/HDL ratio (p = 0.009), systolic BP (p = 0.000), and WC (p = 0.000) were observed. In the correspondence analysis, the eutrophic group presented expected values for lipid variables.

Conclusion:

Overweight indicators are associated with cardiometabolic risk factors, reinforcing the need for early monitoring.

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IJCS

Original Article

The Relationship Between Inflammatory Markers and Supraventricular Tachycardia in Children

Sevval Durgut et al. Hikmet Kıztanır Yasin Yıldız

Abstract

Background

Supraventricular tachycardia (SVT) is a common arrhythmia in pediatric patients. Emerging evidence suggests a link between systemic inflammation and cardiovascular diseases.

Objectives

This study aims to investigate the relationship between the monocyte/lymphocyte ratio (MLR) and neutrophil/lymphocyte ratio (NLR) with SVT in pediatric patients. Methods: We conducted a retrospective study at Rize Education and Research Hospital’s Pediatric Health and Diseases Department, including 33 patients diagnosed with SVT and 33 control subjects without sinus tachycardia. Hemogram (CBC) parameters, electrocardiography (ECG), and echocardiography (ECHO) were evaluated. NLR and MLR were calculated. The unpaired t-test is designed to compare the means of continuous variables between two groups, while the Mann-Whitney U test was applied for data not following a normal distribution. Correlations between values were analyzed through Pearson correlation. A significance level of p <0.05 was accepted.

Results

There was no significant difference between the groups in terms of age, lymphocyte count, hemoglobin, hematocrit, platelet count, and NLR. However, leukocyte count, monocyte count, and MLR showed significant differences (p<0.05). The SVT group had higher MLR values compared to the control group.

Conclusions

Our study found that MLR was significantly higher in pediatric patients with SVT compared to controls, suggesting a potential role of inflammation in SVT pathogenesis. Further large-scale, prospective, and multicenter studies are needed to confirm these findings and clarify the relationship between inflammation markers and SVT.

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ABC

Case Report

Percutaneous Retrieval of a Vegetation in a Pediatric Patient with Patent Ductus Arteriosus: A New Technique to Avoid Thoracotomy

Miguel Fabian Barrerra-Colín et al. José Luis Colín-Ortiz Carlos Alfonso Corona-Villalobos

Abstract

Infective endocarditis in the pediatric population is a rare condition that may or may not be associated with a congenital heart disease. Current treatment modalities are based on long-term antibiotic therapy and surgical resection as the first option for cases of persistent vegetation. We present a case of successful percutaneous retrieval of a vegetation in a patent ductus arteriosus, that extended to the pulmonary artery trunk in a pediatric patient. This is the first report in the literature on this type of extraction of vegetation in the ductus arteriosus without thoracotomy.

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ABC

Review Article

Cardiomyopathy in Children and Adolescents in the Era of Precision Medicine

Ana Flávia Mallheiros Torbey et al. Raquel Germer Toja Couto Aurea Grippa Eduarda Corrêa Maia … Sara Aimée Miranda Marcos Adriano Cardoso dos Santos Elion Tavares Peres Olimpio Patrick Silva Costa Everton Mattos de Oliveira Evandro Tinoco Mesquita

Abstract

In childhood and adolescence, cardiomyopathies have their own characteristics and are an important cause of heart failure, arrhythmias, sudden death, and indication for heart transplantation. Diagnosis is a challenge in daily practice due to its varied clinical presentation, heterogeneous etiologies, and limited knowledge of tools related to clinical and molecular genetics. However, it is essential to recognize the different phenotypes and prioritize the search for the etiology. Recent advances in precision medicine have made molecular diagnosis accessible, which makes it possible to individualize therapeutic approaches, stratify the prognosis, and identify individuals in the family who are at risk of developing the disease. The objective of this review is to emphasize the particularities of cardiomyopathies in pediatrics and how the individualized approach impacts the therapy and prognosis of the patient. Through a systematized approach, the five-stage protocol used in our service is presented. These stages bring together clinical evaluation for determining the morphofunctional phenotype, identification of etiology, classification, establishment of prognosis, and the search for personalized therapies.

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ABC

Editorial

PRKAG2 Syndrome: Is Screening with Early Echocardiography Effective in Children with a Positive Genotype?

Maria Elisa Lucena Sales de Melo Assunção et al. Norma Lucena Cavalcanti Licínio da Silva Mychelle Pascoaline de Miranda Silva

Described for the first time in 2001 by Gollob et al., the syndrome determined by the mutation of the PRKAG2 gene is rare, autosomal dominant, with high penetrance and unknown prevalence in the population. It manifests with the phenotype of myocardial hypertrophy and associated ventricular pre-excitation. Tachyarrhythmias are common in this genetic syndrome, as are disturbances in the cardiac conduction system that lead, in some cases, to pacemaker implantation at an early age.

The PRKAG2 gene mutation usually presents as a phenocopy of hypertrophic cardiomyopathy, differing from this in that there are no sarcomeric changes and, rather, accumulation of glycogen in cardiac myocytes. The definitive diagnosis is given by genetic study, but the presentation with left ventricular (LV) hypertrophy and conduction system disorders also form a differential diagnosis with Danon and Anderson-Fabry diseases.

[…]

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ABC

Original Article

Echocardiographic Findings in Children of Patients Diagnosed with PRKAG2 Syndrome

Dinamar Amador dos Santos Neto et al. Igor de Souza Neto Alice Pinheiro Barbosa Eduardo Back Sternick José Luiz Barros Pena

Abstract

Background:

PRKAG2 syndrome typically manifests in adolescence and early adulthood, progressing with left ventricular hypertrophy, arrhythmias, and risk of sudden death. Findings of echocardiographic markers before clinical manifestation in children of patients affected by the disease can facilitate prevention strategies and therapeutic planning for this patient group.

Objective:

To identify the existence of echocardiographic findings that manifest early in children of parents affected by PRKAG2 syndrome, while they are still asymptomatic.

Methods:

In this cross-sectional observational study, 7 participants who were children of parents with established diagnosis of PRKAG2 syndrome, between the ages of 9 months and 12 years, with proven genetic diagnosis, underwent conventional and advanced echocardiography. Their findings were compared to those of a control group composed of 7 age- and sex-matched volunteers who were healthy from a cardiovascular point of view. P values < 0.05 were considered significant.

Results:

Conventional echocardiography showed statistically significantly higher values in the case group for left atrium, interventricular septum, left ventricular posterior wall, indexed ventricular mass, and relative wall thickness (p < 0.05). Global longitudinal systolic strain on 2-dimensional echocardiography did not show statistical significance between the case and control groups. None of the parameters on 3-dimensional echocardiography showed statistical significance between groups.

Conclusion:

Children diagnosed with PRKAG2 showed echocardiographic findings indicative of a tendency toward cardiac hypertrophy. Echocardiography can be a useful tool in the evaluation and follow-up of this patient group before the onset of clinical manifestations.

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ABCHF

Original Article

Heart Failure in Children and Adolescents with Covid-19: A Systematic Review of the Literature

Lucas Quaresma Martins et al. Gabriel Ribeiro de Souza Daniel Garcia da Gama Alves Kaylane Fernanda Costa de Melo … Paula Cordeiro Aguiar de Almeida Ádria Rayane Lima Cascaes Antonio Maria Zacarias Araújo Monteiro

Abstract

Background:

Cardiovascular structural/functional changes caused by COVID-19 may be related to the presence of heart failure (HF), especially in children and adolescents, as the SARS-CoV-2 virus invades cardiomyocytes, leading to cardiac dysfunction.

Objective:

To assess the mechanism by which COVID-19 becomes a risk factor for the development of HF in children and adolescents.

Methods:

This was a systematic literature review of articles indexed in PubMed, BVS and SciELO, following the PRISMA recommendations. DeCS/MeSH descriptors were used in the search.

Results:

A total of 685 studies were identified: 418 in Pubmed, 264 in BVS and three in SciELO. After exclusion of 160 duplicate articles, and analysis of titles and abstracts, 14 articles were read in full, and 10 selected for the final sample. All articles were published between 2020 and 2022; there were 10 cohort studies (eight retrospective and two prospective). Six articles addressed the Multisystem Inflammatory Syndrome in Children (MIS-C), and four articles addressed the reduction in left ventricular ejection fraction in COVID-19 patients.

Conclusions:

Most patients recovered without cardiovascular sequelae, although MIS-C may cause severe systemic failure, which led to death in some studies. More research and more comprehensive studies on this theme are warranted.

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ABC

Editorial

Is Left Atrial Strain the Missing Part to Diagnose Diastolic Dysfunction in Children with Chronic Kidney Disease?

José Luiz Barros Pena

Echocardiography is the most critical imaging modality for assessing diastolic function, an essential part of the cardiac function evaluation.

Since its publication in 2016, the ASE/EACVI recommendations for evaluating diastolic function have been validated in different cohorts but have shown conflicting results, especially when considering patients with preserved ejection fraction (EF). When patients with preserved EF were studied in a separate subgroup, a poorer sensitivity was observed.

[…]

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ABC

Original Article

Incidence of Cardiovascular Complications in Pediatric Patients Treated with Anthracyclines at a Brazilian Cancer Center

Cristina Chaves dos Santos de Guerra et al. Geisa Sant'Ana Osório Luiz Rangel de Almeida

Abstract

Background:

The introduction of anthracyclines in the treatment of children and adolescents with cancer has promoted a significant increase in survival, but also in morbidity and mortality rates due to cardiovascular (CV) complications.

Objectives:

To determine the cardiovascular profile of pediatric patients treated with anthracyclines at a cancer center in Brazil and the incidence of CV complications.

Methods:

The following data were collected from the medical records of patients of both sexes, aged younger than 19 years – frequency and form of clinical presentation of general CV complications (G1) and CV complications related to ventricular dysfunction (G2) – and correlated with risk factors, age range and vital status, cardiovascular and cardioprotective medications. A p<0.05 was considered statistically significant.

Results:

A total of 326 patients were included, 214 (65.6%) were younger than 10 years and 192 (58.9%) of male sex. G1 complications occurred in 141 (43.3%) patients, and the most frequent was systemic arterial hypertension; G2 complications occurred in 84 patients (25.8%). Cumulative dose (CD) of anthracyclines > 250mg/m² was used in 26.7% of patients and the association of G2 complications with this CD was not statistically significant (p=0.305; OR=1.330 and [95% CI = 0.770- 2.296]). The most used cardiac medications were diuretics (34.7% of patients).

Conclusions:

In accordance with literature, the study showed a high incidence of CV complications in the treatment of children and adolescents with cancer, with general CV complications as the most prevalent.

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ABC

Original Article

Speckle-Tracking: Incremental Role in Diastolic Assessment of Pediatric Patients with Chronic Kidney Disease

Flora Maciel Penachio et al. Maria de Fátima Rodrigues Diniz Rosana Sbruzzi Prado Laurino Andreia Watanabe … Karen Saori Shiraishi Sawamura Alessandro Cavalcanti Lianza Carolina Rocha Brito Menezes Isabela de Sousa Lobo Silva Gabriela Nunes Leal

Abstract

Background:

Cardiovascular complications are the leading cause of mortality in pediatric patients with chronic kidney disease (CKD). Echocardiographic assessment of diastolic function in CKD has been limited to spectral and tissue Doppler imaging, known to be less reliable techniques in pediatrics. Two-dimensional Speckle tracking echocardiography (2DST) derived left atrial (LA) strain has recently been confirmed as a robust measure of diastolic function.

Objectives:

To investigate LA strain role in diastolic assessment of children at different stages of CKD.

Methods:

From February 2019 to July 2022, 55 CKD patients without cardiovascular symptoms and 55 controls were evaluated by standard and 2DST echocardiograms. The level of significance was set at 5% (p<0.05).

Results:

Patients and controls had similar age [9.78 (0.89 – 17.54) vs. 10.72 (1.03 –18,44) years; p = 0.41] and gender (36M:19F vs. 34M:21F; p=0.84). There were 25 non-dialysis patients and 30 dialysis patients. Left ventricular ejection fraction was ≥ 55% in all of them. Comparing CKD and controls, LA reservoir strain was lower (48.22±10.62% vs. 58.52±10.70%) and LA stiffness index was higher [0.14 (0.08–0.48)%^-1 vs. 0.11 (0.06–0.23) %^-1]; p<0.0001. LV hypertrophy was associated with lower LA reservoir strain (42.05±8.74% vs. 52.99±9.52%), higher LA stiffness [0.23(0.11 – 0.48)%^-1 vs. 0.13 (0.08–0.23) %^-1 and filling indexes (2.39±0.63 cm/s x %^-1 vs. 1.74±0.47 cm/s x %^-1; p<0.0001. Uncontrolled hypertension was associated with lower LA reservoir strain (41.9±10.6% vs. 50.6±9.7; p=0.005).

Conclusions:

LA strain proved to be a feasible tool in the assessment of pediatric CKD patients and was associated with known cardiovascular risk factors.

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ABC

Editorial

Has the Natural History of Primary Heart Tumors in Children Been Modified Recently?

Vera Demarchi Aiello

Morphology of the nodular lesions of the fetal and neonatal heart

The most frequent nodular lesions of the fetal and neonatal heart are rhabdomyomas and fibromas, which are considered hamartomas.

In rhabdomyoma cells, the lack of proliferative immunohistochemical markers indicates that these lesions are more likely hamartomas rather than true neoplasms.

[…]

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ABC

Original Article

Myocardial Injury Progression after Radiofrequency Ablation in School-Age Children

Sissy Lara de Melo et al. Alberto Pereira Ferraz Stephanie Ondracek Lemouche Marcela Santana Devido … Gabriela Liberato de Sousa Carlos E. Rochitte Cristiano Faria Pisani Denise Tessariol Hachul Mauricio Scanavacca

Abstract

Background

The past decades have seen the rapid development of the invasive treatment of arrhythmias by catheter ablation procedures. Despite its safety and efficacy being well-established in adults, to date there has been little data in pediatric scenarios. One of the main concerns is the possible expansion of the ablation procedure scar in this population and its consequences over the years.

Objectives

This study aimed to analyze the risk of myocardial injury progression after radiofrequency catheter ablation in pediatric patients.

Methods

This is a retrospective study of 20 pediatric patients with previous ablation for treatment of supraventricular arrhythmia that underwent cardiac magnetic resonance and coronary angiography for evaluation of myocardial fibrosis and the integrity of the coronary arteries during follow-up.

Results

The median age at ablation procedure was 15.1 years (Q1 12.9, Q3 16.6) and 21 years (Q1 20, Q3 23) when the cardiac magnetic resonance was performed. Fourteen of them were women. Nodal reentry tachycardia and Wolf-Parkinson-White Syndrome were the main diagnosis (19 patients), with one patient with atrial tachycardia. Three patients had ventricular myocardial fibrosis, but with a volume < 0.6 cm ³ . None of them developed ventricular dysfunction and no patient had coronary lesions on angiography.

Conclusion

Radiofrequency catheter ablation did not show to increase the risk of myocardial injury progression or coronary artery lesions.

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ABCHF

Viewpoint

Post-COVID-19 Cardiomyopathy in Children and Adults: Fact or Fiction?

Anna Esther Araujo e Silva et al. Ana Flavia Malheiros Torbey Aurea Lucia Alves de Azevedo Grippa de Souza

Since the emergence of the novel coronavirus 2019 disease (COVID-19), cardiovascular impairment and alterations in cardiology laboratory tests suggestive of myocardial injury, even in patients without cardiovascular symptoms, have been observed in hospitalized children and adults.^–

Epidemiological data from China have suggested that cardiac injury may occur in 19% to 28% of hospitalized patients with COVID-19. Several factors seem to contribute to myocardial damage, and potential mechanisms of injury include: hypoxic injury, stress cardiomyopathy, ischemic lesion caused by cardiac microvascular dysfunction, small vessel cardiac vasculitis, endotheliitis, epicardial coronary artery disease, right heart distention (acute cor pulmonale with pulmonary embolism), myocarditis, systemic inflammatory response syndrome (cytokine storm), and others ^, ().

[…]

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ABCHF

Review Article

Pediatric Cardiomyopathies: Establishing Genotype-Phenotype Relationship as a Determinant in Prognosis and Therapy: A Review of the Literature

Ana Flavia Malheiros Torbey et al. Aurea Lucia Alves de Azevedo Grippa de Souza Estela Azeka Maraisa Fachini Spada

Abstract

Cardiomyopathies constitute a heterogeneous group of diseases with varying etiologies and clinical presentation. Advances in genetic testing have made it possible to establish genotype-phenotype relationships, determine prognosis, and choose specific treatments in the pediatric population. Therefore, the objective of this review is to assist clinical reasoning and underscore the importance of etiological diagnosis in different disease phenotypes.

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ABC

Original Article

Clinical and Autonomic Profile, and Modified Calgary Score for Children and Adolescents with Presumed Vasovagal Syncope Submitted to the Tilt Test

Pamela Michelle Leite Oliveira et al. Rose Mary Ferreira Lisboa da Silva Henrique de Assis Fonseca Tonelli Zilda Maria Alves Meira Cleonice de Carvalho Coelho Mota

Abstract

Background

In the pediatric population, syncope is mainly from vasovagal (VVS) origin. Its evaluation must be done by clinical methods, and the tilt test (TT) can contribute to the diagnosis.

Objectives

To analyze the clinical profile, Calgary and modified Calgary scores, response to TT and heart rate variability (HRV) of patients aged ≤ 18 years with presumed VVS. To compare the variables between patients with positive and negative responses to TT.

Method

Observational and prospective study, with 73 patients aged between 6 and 18 years, submitted to clinical evaluation and calculation of scores without previous knowledge of the TT. It was done at 70º under monitoring for HRV analysis. P-value < 0.05 was the statistical significance criterion.

Results

Median age was 14.0 years; 52% of participants were female, 72 had Calgary ≥ -2 (mean 1.80), and 69 had modified Calgary ≥ -3 (mean 1.38). Prodromes were observed in 59 patients, recurrence in 50 and trauma in 19. The response to TT was positive in 54 participants (49 vasovagal, with 39 vasodepressor responses), with an increase in the low frequency (LF) component and a decrease in the high frequency (HF) component (p < 0,0001). In the supine position, LF was 33.6 in females and 47.4 in normalized units for males (p = 0.02). When applying the operating characteristic curve for positive TT, there was no statistical significance for HRV and scores.

Conclusion

Most children and adolescents with a presumed diagnosis of VVS presented a typical clinical scenario, with a Calgary score ≥ -2, and a predominant vasodepressor response to TT. Greater sympathetic activation was observed in the supine position in males. Calgary scores and sympathetic activation did not predict the response to TT.

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ABCHF

Viewpoint

Post-COVID Cardiomyopathy

Marcio Roberto Moraes de Carvalho et al. Jocemir Ronaldo Lugon Antonio Jose Lagoeiro Jorge

Myocardial inflammation, COVID-19, and HFpEF

Myocardial inflammation is widely considered to be one of the main factors in the development of heart failure (HF). It is believed that persistent myocardial inflammation plays a central role in the development of adverse left ventricular remodeling after myocardial infarction, as well as in the pathogenesis of dilated cardiomyopathy and heart failure with preserved ejection fraction (HFpEF).^–

In May 2020, Tavazzi et al. reported the first case of acute cardiac injury with the finding of SARS-CoV-2 particles and low-grade inflammation in the myocardium, not accompanied by cardiomyocyte necrosis. An important discussion is whether the myocardial changes are caused by direct viral damage to the heart or vasculature or by a cytokine storm related to the infection. It is mainly known that cardiac inflammatory changes induced by viruses are capable of triggering HFpEF and heart failure with reduced ejection fraction. There is currently a growing interest in identifying patients with COVID-19 at risk of developing virus-related HF and cardiovascular problems.

[…]

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ABC

Editorial

Obesity and Risk of Hypertension: A Growing Problem in Children and Adolescents

José Geraldo Mill

Arterial hypertension (AH) affects approximately 30% of adults in Brazil. A previously rare condition in children and adolescents, this situation has been changing given the obesity pandemic currently occurring in this age group.

Primary AH is a complex disease, as its appearance depends on genetic predisposition and factors linked to lifestyle. There is still no robust and easily obtainable genetic score to be used clinically as a predictor of AH. The same does not occur with the lifestyle factors, as it is known that a sedentary lifestyle, obesity, high salt intake and insulin resistance, predisposes to blood pressure increase throughout life.

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Original Article

Sedentary Behavior, Dietary Habits, and Cardiometabolic Risk in Physically Active Children and Adolescents

Paula Adriana dos Santos de Fontes et al. Jordana Herzog Siqueira Haysla Xavier Martins Polyana Romano Oliosa … Divanei Zaniqueli José Geraldo Mill Rafael de Oliveira Alvim

Abstract

Background

Sedentary behavior has been associated with several cardiometabolic risk factors during childhood. However, little is known about the impact of sedentary behavior on the health and eating habits of physically active children and adolescents.

Objective

To evaluate the association between sedentary behavior and cardiometabolic risk factors and eating habits in physically active children and adolescents.

Methods

This cross-sectional study was conducted, including 516 physically active children and adolescents (10 to 18 years old; both sexes) enrolled in the social project “Estação Conhecimento-Vale” were evaluated. Biochemical and lifestyle variables (questionnaire) were collected. Sedentary behavior was determined indirectly (questionnaire), by using sitting time ≥ 3 hours per day as a cutoff point. A p-value < 0.05 was considered statistically significant for all tests.

Results

Sedentary behavior was not associated with overweight/obesity (odds ratio = 0.72 [95% confidence interval (CI): 0.325-1.389]), hypertriglyceridemia (odds ratio = 0.63 [95% CI: 0.306-1.297]), low HDL cholesterol (odds ratio = 0.57 [95% CI: 0.323-1.019]), or high non-HDL cholesterol (odds ratio = 0.63 [95% CI: 0.283-1.389]). However, children and adolescents with sedentary behavior were more likely to regularly consume food in front of the television (odds ratio = 1.96 [95% CI: 1.114-3.456]) and to consume at least one ultra-processed food per day (odds ratio = 2.42 [95% CI: 1.381-4.241]). In addition, they were less likely to consume fruit regularly (odds ratio = 0.52 [95% CI: 0.278-0.967]).

Conclusion

There was no association between sedentary behavior and cardiometabolic risk factors in physically active children and adolescents. However, sedentary behavior was associated with inadequate eating habits. Thus, we may suggest that the regular engagement in physical activity may attenuate the deleterious effects of sedentary behavior on the cardiometabolic parameters of children and adolescents.

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