ISRCTN registry: Registration number ISRCTN19016626, registered 23 January 2013.
The course of type 1 diabetes in children can be complicated by cardiovascular disorders in the form of life-threatening arrhythmias, especially in patients with congenital long QT syndrome (LQTS). It remains relevant to determine the risk groups for developing such complications, to search for convenient diagnostic algorithms and subsequent management tactics for children with type 1 diabetes mellitus (T1DM) who have acquired and congenital long LQTS. Study purpose is to determine the risk groups for the development of cardiovascular complications of type 1 diabetes mellitus in children, by the QT and corrected (QTc) interval ranges. Materials and methods. The examination involved 53 children with type 1 diabetes, who were divided into 2 groups depending on the duration of the disease. To determine the parameters relevant for the study, the bioelectrical activity of the heart was assessed by ECG and Holter ECG monitoring. For additional assessment of the patients' condition over a long period of time, they were offered to keep a diary with monitoring of parameters important for the study. Statistical processing of the research results was carried out with the SPSS 22.0 program. Results and conclusions. Changes in the duration of the QTc interval and its variance have been proved depending on the duration of the disease and influence of the glycemia level plus insulin therapy on the value of these indicators. For children with newly diagnosed type 1 diabetes, an algorithm has been developed to identify risk groups for the development of cardiovascular complications associated with LQTS, which makes it possible to determine three risk groups and the tactics of their further management. According to the authors, the main goal of reducing the risk of developing cardiovascular complications in the form of ventricular arrhythmias (which can lead to sudden death syndrome) is the timely diagnosis of long QT interval syndrome. Recognition of congenital LQTS is important, since unstable glycemic levels and the appointment of insulin therapy can significantly worsen the child's condition. For children with newly diagnosed type 1 diabetes mellitus before the appointment of insulin therapy, the authors propose their own algorithm for identifying risk groups for the development of cardiovascular complications associated with long QT interval syndrome and tactics for their further management. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: type 1 diabetes, long QT syndrome, patient management algorithm.
The problem of cardiovascular diseases diagnosing is topical. The prevalence of mitral valve prolapse (MVP) has been increasing over the past decades, which requires a differentiated study to prevent its complications in children. Purpose - to explore the reaction of the autonomic nervous system to physical exercises in children with MVP, taking into account the mitral regurgitation (MR). Materials and methods. 44 children with MVP were examined and divided into two groups considering MR aged from 13 to 17 years old. The Group 1 consisted from 20 (45.5%) children with MVP without MR, the Group 2 - 24 (54.5%) children with MVP without MR. It were studied the influence of physical activity on the state of vegetative homeostasis in these children. The estimation of autonomic system state and heart rhythm variability parameters, including spectral and frequency analyses were conducted by cardiointervalography. Estimation of these parameters was performed after physical exercises and compared with primary results. Results. Increasing of VLf (Very low frequency) and Lf (Low frequency) data parameters on 32.7% and 65.6% in children with MVP without MR was noted which shows the prevalence of sympathetic part of autonomic nervous system (ANS), while in children with MR - on 40.5% and 85%, respectively, that is 7.8 and 19.5% more than in children without MR. This can be associated with increased sympathicotonia against the background of the MR presence. Among the parameters which describe the parasympathetic part of the ANS, there was an increase in Hf (High frequency) by 67.0% in children without MR, when it appears, this parameter decreases by 9,1% - we observe an increase in relative sympathicotonia. Increase of sympathetic tonus was also noted in Lf/Hf elevation by 3.8% (without MR) and by 28% (with MR). The analysis of heart rate variability (HRV) time parameters expectedly had changes within reducing of SDNN (Standard deviation of the NN (R-R) intervals) by almost half (p<0.05) in children of both subgroups and the increase of rMSSD (root mean square of successive R-R interval differences) by 23.2% in children without MR (р<0.05), and with the appearance of MR decrease of this parameter by 24.3% was noted. Therefore, in children with MVP, with the appearance of MR, changes in the parameters that characterize the state of ANS with sympathicotonia increasing and parasympathicotonia weakening. Conclusions. In children with MVP, against the background of physical exertion, there is an increase in changes in the balance of the ANS, regardless to the presence or absence of MR. In children with MVP, against the background of MR, the influence of the sympathetic division of the ANS increases almost twice after physical exertion. These children should be under the close supervision of pediatricians, pediatric cardiologists and family doctors. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.
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