Subclinical Myocardial Dysfunction in Children With Wilson's Disease
Assessment of Subtle Myocardial Dysfunction in Children With Wilson's Disease: A Case-Control Study
Wilson's disease (WD) is one of the most common metabolic liver diseases in older children. The most frequent clinical presentation is liver disease. However, Wilson's disease (WD) is a multisystem disorder. It is concluded that four modes of cardiac manifestations in Wilson's disease (WD) include arrhythmias, cardiomyopathy, cardiac death, and autonomic dysfunction. Such possible cardiac involvement should be added to the clinical picture of Wilson's disease (WD) involving the hepatic and central nervous system(CNS).
The data on cardiac manifestations in children is very limited and only few adult studies are available.
In this study, the investigators aim to unveil subclinical cardiac dysfunction in children with Wilson's disease with apparently normal cardiac functions by conventional assessment.
Studienübersicht
Status
Status
Bedingungen
Bedingungen
Intervention / Behandlung
Intervention / Behandlung
Detaillierte Beschreibung
Studientyp
Studientyp
Einschreibung (Geschätzt)
Einschreibung
Kontakte und Standorte
Studienorte
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Cairo, Ägypten
- Faculty of medicine AinShams U
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Giza, Ägypten
- National Hepatology and Tropical Research Institute (NHTMRI)
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Teilnahmekriterien
Zulassungskriterien
Zulassungskriterien
Studienberechtigtes Alter
- Kind
- Erwachsene
Akzeptiert gesunde Freiwillige
Probenahmeverfahren
Studienpopulation
They will be divided in to 2 groups: - Group 1: Patients confirmed Wilson's disease. - Group 2: Controls.
- Patients group: Patient diagnosed as WD patients, following up in Pediatric Hepatology Clinic in NHTMRI.
According to Criteria of diagnosis based on Leipzig scoring system (11,12): Typical clinical symptoms and signs, as: Kayser-Fleischer rings, neurological symptoms, serum ceruloplasmin, Coombs-negative hemolytic anemia. Other tests: Liver biopsy, 24hr urinary Cu, gene analysis.
Beschreibung
Inclusion Criteria
- Confirmed diagnosis of Wilson's disease based on Leipzig scoring criteria (including clinical signs, Kayser-Fleischer rings, low ceruloplasmin, or genetic analysis).
- Age between 4 years and 18 years.
- Written informed consent obtained from parents or legal guardians.
Exclusion Criteria
- Children with clinical evidence of overt heart failure or known congenital heart disease.
- Children suffering from fulminant hepatitis.
- Known co-existing primary liver diseases other than Wilson's disease.
- Presence of syndromic disorders or major congenital anomalies.
Studienplan
Wie ist die Studie aufgebaut?
Designdetails
Anzahl der Gruppen / Kohorten
Kohorten und Interventionen
Gruppe / KohorteGruppe / Kohorte |
Intervention / BehandlungIntervention / Behandlung |
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Group 1 (Cases)
Children aged 4-18 years with confirmed Wilson's disease recruited from the Pediatric Hepatology Clinic at the National Hepatology and Tropical Medicine Research Institute (NHTMRI).
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a safe, painless test that uses sound waves to create moving pictures of your heart's structure and pumping function.
Andere Namen:
a quick, painless test that records the electrical signals in the heart.
Andere Namen:
a protein made by our heart, examined by peripheral blood sample.
Andere Namen:
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Group 2 (Controls)
Age- and sex-matched control children without chronic liver or cardiac illness recruited from the outpatient clinic.
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a safe, painless test that uses sound waves to create moving pictures of your heart's structure and pumping function.
Andere Namen:
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Was misst die Studie?
Primäre Ergebnismessungen
Primäre Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
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Left Ventricular Peak Longitudinal Strain (LV-PLS)
Zeitfenster: Baseline (Day 1 , at single cross-sectional evaluation).
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Left Ventricular Peak Longitudinal Strain (LV-PLS) assessed by Speckle Tracking Echocardiography (STE) to evaluate subclinical LV systolic dysfunction.
Expressed as a negative percentage (%), where a less negative percentage indicates impaired function.
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Baseline (Day 1 , at single cross-sectional evaluation).
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Sekundäre Ergebnismessungen
Sekundäre Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
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Serum Pro-Brain Natriuretic Peptide (Pro-BNP) Level
Zeitfenster: Baseline (Day 1 , at single cross-sectional evaluation).
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Quantitative measurement of serum Pro-BNP assessed via ELISA (pg/mL) as a circulating biomarker of cardiac wall stress.
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Baseline (Day 1 , at single cross-sectional evaluation).
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Tissue Doppler LV Filling Pressure (E/e' Ratio)
Zeitfenster: Baseline (Day 1 , at single cross-sectional evaluation).
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Ratio of early mitral inflow velocity (E) measured by conventional Doppler to early diastolic mitral annular velocity (e') measured by tissue Doppler imaging to evaluate LV diastolic function.
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Baseline (Day 1 , at single cross-sectional evaluation).
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Serum Ceruloplasmin Level Correlation
Zeitfenster: Baseline (Day 1,at time of cardiac evaluation or within 6 months preceding cardiac evaluation).
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Serum ceruloplasmin levels (mg/dL) measured within 6 months of cardiac evaluation to correlate hepatic copper transport marker levels with cardiac function parameters.
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Baseline (Day 1,at time of cardiac evaluation or within 6 months preceding cardiac evaluation).
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Frequency of Electrocardiographic (ECG) Abnormalities
Zeitfenster: Baseline (Day 1 , at single cross-sectional evaluation).
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Presence or absence of cardiac electrical abnormalities, including conduction delays, ST-T wave changes, and arrhythmias recorded on standard 12-lead ECG.
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Baseline (Day 1 , at single cross-sectional evaluation).
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Mitarbeiter und Ermittler
Sponsor
Sponsor
Ermittler
Ermittler
- Hauptermittler: Hebatullah I Fawzy, Msc Student, Faculty of medicine AinShams U,National Hepatology and Tropical Research Institute (NHTMRI)
- Studienstuhl: Eman M ElSayed (Assistant Professor of Pediatrics), AssProfessor, Faculty of medicine AinShams U
- Studienleiter: Mona AH Khafagy (Lecturer of Pediatrics), Lecturer, Faculty of medicine AinShams U
- Studienleiter: Sara M Osman (Teaching Fellow of Pediatrics), PedFellow, National Hepatology and Tropical Research Institute (NHTMRI)
Publikationen und hilfreiche Links
Allgemeine Veröffentlichungen
- Wiernicka A, Dadalski M, Janczyk W, Kaminska D, Naorniakowska M, Husing-Kabar A, Schmidt H, Socha P. Early Onset of Wilson Disease: Diagnostic Challenges. J Pediatr Gastroenterol Nutr. 2017 Nov;65(5):555-560. doi: 10.1097/MPG.0000000000001700.
- European Association for the Study of the Liver. EASL-ERN Clinical Practice Guidelines on Wilson's disease. J Hepatol. 2025 Feb 22:S0168-8278(24)02706-5. doi: 10.1016/j.jhep.2024.11.007. Online ahead of print.
- European Association for Study of Liver. EASL Clinical Practice Guidelines: Wilson's disease. J Hepatol. 2012 Mar;56(3):671-85. doi: 10.1016/j.jhep.2011.11.007.
- https://ebm.one/en/chapter-table/scoring-system-developed-8th-international-meeting-wilson-disease-leipzig-2001
- https://doi.org/10.4236/wjcd.2019.93018
- Romuk E, Jachec W, Zbrojkiewicz E, Mroczek A, Niedziela J, Gasior M, Rozentryt P, Wojciechowska C. Ceruloplasmin, NT-proBNP, and Clinical Data as Risk Factors of Death or Heart Transplantation in a 1-Year Follow-Up of Heart Failure Patients. J Clin Med. 2020 Jan 3;9(1):137. doi: 10.3390/jcm9010137.
- Salatzki J, Mohr I, Heins J, Cerci MH, Ochs A, Paul O, Riffel J, Andre F, Hirschberg K, Muller-Hennessen M, Giannitsis E, Friedrich MG, Merle U, Weiss KH, Katus HA, Ochs M. The impact of Wilson disease on myocardial tissue and function: a cardiovascular magnetic resonance study. J Cardiovasc Magn Reson. 2021 Jun 24;23(1):84. doi: 10.1186/s12968-021-00760-1.
- Chevalier K, Benyounes N, Obadia MA, Van Der Vynckt C, Morvan E, Tibi T, Poujois A. Cardiac involvement in Wilson disease: Review of the literature and description of three cases of sudden death. J Inherit Metab Dis. 2021 Sep;44(5):1099-1112. doi: 10.1002/jimd.12418. Epub 2021 Aug 2.
- Quick S, Reuner U, Weidauer M, Hempel C, Heidrich FM, Mues C, Sveric KM, Ibrahim K, Reichmann H, Linke A, Speiser U. Cardiac and autonomic function in patients with Wilson's disease. Orphanet J Rare Dis. 2019 Jan 28;14(1):22. doi: 10.1186/s13023-019-1007-7.
- https://doi.org/10.21608/cupsj.2021.71046.1018
- Sanchez-Monteagudo A, Ripolles E, Berenguer M, Espinos C. Wilson's Disease: Facing the Challenge of Diagnosing a Rare Disease. Biomedicines. 2021 Aug 28;9(9):1100. doi: 10.3390/biomedicines9091100.
- Ovchinnikova EV, Garbuz MM, Ovchinnikova AA, Kumeiko VV. Epidemiology of Wilson's Disease and Pathogenic Variants of the ATP7B Gene Leading to Diversified Protein Disfunctions. Int J Mol Sci. 2024 Feb 18;25(4):2402. doi: 10.3390/ijms25042402.
- https://doi.org/10.1038/s41598-024-59377-w
- Dang J, Chevalier K, Letavernier E, Tissandier C, Mouawad S, Debray D, Obadia M, Poujois A. Kidney involvement in Wilson's disease: a review of the literature. Clin Kidney J. 2024 Mar 9;17(4):sfae058. doi: 10.1093/ckj/sfae058. eCollection 2024 Apr.
Studienaufzeichnungsdaten
Haupttermine studieren
Studienbeginn (Tatsächlich)
Studienbeginn
Primärer Abschluss (Geschätzt)
Primärer Abschluss
Studienabschluss (Geschätzt)
Studienabschluss
Studienanmeldedaten
Zuerst eingereicht
Zuerst eingereicht
Zuerst eingereicht, das die QC-Kriterien erfüllt hat
Zuerst eingereicht, das die QC-Kriterien erfüllt hat
Zuerst gepostet (Tatsächlich)
Zuerst gepostet
Studienaufzeichnungsaktualisierungen
Letztes Update gepostet (Tatsächlich)
Letztes Update gepostet
Letztes eingereichtes Update, das die QC-Kriterien erfüllt
Letztes eingereichtes Update, das die QC-Kriterien erfüllt
Zuletzt verifiziert
Zuletzt verifiziert
Mehr Informationen
Begriffe im Zusammenhang mit dieser Studie
Schlüsselwörter
Zusätzliche relevante MeSH-Bedingungen
- Erkrankungen des Gehirns
- Erkrankungen des zentralen Nervensystems
- Erkrankungen des Nervensystems
- Herz-Kreislauf-Erkrankungen
- Herzkrankheiten
- Stoffwechsel, angeborene Fehler
- Genetische Krankheiten, angeboren
- Stoffwechselerkrankungen
- Erkrankungen des Verdauungssystems
- Neurodegenerative Krankheiten
- Leberkrankheiten
- Bewegungsstörungen
- Heredodegenerative Erkrankungen, Nervensystem
- Ventrikuläre Dysfunktion
- Erkrankungen der Basalganglien
- Gehirnerkrankungen, Stoffwechselerkrankungen, angeboren
- Gehirnerkrankungen, Stoffwechsel
- Metallstoffwechsel, angeborene Fehler
- Angeborene, erbliche und neonatale Krankheiten und Anomalien
- Ernährungs- und Stoffwechselerkrankungen
- Ventrikuläre Dysfunktion, links
- Hepatolentikuläre Degeneration
- Diagnosetechniken und Verfahren
- Diagnose
- Diagnostische Bildgebung
- Diagnosetechniken, kardiovaskulär
- Herzfunktionstests
- Elektrodiagnose
- Herzbildgebungstechniken
- Ultraschall
- Elektrokardiographie
- Echokardiographie
Andere Studien-ID-Nummern
Andere Studien-ID-Nummern
- Wilson's disease and Heart
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