Subclinical Myocardial Dysfunction in Children and Adolescents with Celiac Disease: A Cross-Sectional Case-Control Study.

Abstract

Celiac disease (CD) is recognized as a systemic disorder extending beyond the gastrointestinal tract, with evidence of subclinical cardiovascular involvement emerging even in childhood. We aimed to evaluate myocardial function in children with CD compared to healthy controls, and to investigate whether echocardiographic parameters differ according to gluten-free diet adherence. This cross-sectional case-control study included 142 children with CD and 120 healthy controls. Conventional and advanced echocardiography were performed in all participants. Multivariable linear regression adjusted for sex, age, and body mass index (BMI) z-score was used for all echocardiographic outcomes. Patients were stratified by anti-tissue transglutaminase IgA (anti-tTG IgA) into tTG-negative (n = 55), borderline (n = 13), and positive (n = 74) subgroups. Ejection Fraction (EF) and Fractional Shortening (FS) were modestly but significantly reduced in CD patients, while left ventricular (LV) dimensions and LV mass were not significantly different. All Tissue Doppler Imaging (TDI) parameters were significantly impaired in CD patients, including elevated Myocardial Performance Index (MPI) and E/e' ratios at both septal and lateral mitral annulus (p < 0.001). Myocardial function was impaired across all serological subgroups compared to controls, with no significant differences among celiac subgroups in multivariable analysis. ROC analysis demonstrated excellent discriminatory ability of MPI between celiac patients and healthy controls, after adjustment for age, sex and z-score BMI. Children with CD demonstrate significant subclinical myocardial dysfunction, detectable by TDI, independently of serological disease activity. Prospective longitudinal studies are needed to establish the long-term cardiovascular implications and the role of routine cardiac monitoring in this population.