Subclinical cardiac involvement in Crohn's disease and ulcerative colitis: an echocardiographic case-control study.

Background: Cardiovascular manifestations of inflammatory bowel disease (IBD) are considered rare. The aim of the present study was to assess cardiac structure and function by means of traditional Doppler echocardiography and tissue Doppler imaging in order to better appreciate myocardial subclinical alterations and their future implications for these kind of patients.

Methods: Twenty-seven patients affected by Crohn's disease (CD) and 43 suffering from ulcerative colitis (UC) were enrolled. They were selected without cardiovascular diseases nor risk factors. They were compared with 24 healthy subjects matched for sex and age. Everyone underwent transthoracic echocardiography.

Results: IBD patients had larger left atrial anterior-posterior dimension (34±7 vs. 31±2 mm; P=0.001) and volume (46±7 vs. 41±6; P=0.002), reduced left ventricular (LV) ejection fraction (59±6 vs. 63±5%; P=0.006) and higher pulmonary artery systolic pressure (26±6 vs. 22±2 mmHg; P<0.001) than healthy volunteers. Moreover, LV diastolic function was slightly altered in patients in respect of controls. Atrioventricular valve regurgitation was prevalent in IBD. Finally, we found that 18 (25.7%) patients had mitral valve prolapse, 35 (50.0%) mitral valve leaflets thickening and 3 (4.3%) pericardial effusion. We did not find differences in echocardiographic parameters between CD and UC.

Conclusions: Our study suggests that subclinical cardiac involvement is frequent among IBD patients. The underlying mechanisms require further evaluation, but might be due to a systemic increase in cytokines and profibrotic factors.