Background: Morphological and functional cardiac involvement is rarely described in patients with inflammatory bowel disease (IBD) but there is evidence that they have an increased risk of cardiovascular (CV) events despite the lower prevalence of traditional CV risk factors.
Objectives: Our systematic review and meta-analysis examined the relationship between IBD and cardiac function, namely the incidence of heart failure (HF) and subclinical echocardiographic changes.
Data sources and methods: Two medical databases, PubMed and Scopus, were systematically searched up to September 2022 to identify all studies reporting HF and/or echocardiographic changes in IBD patients.
Results: The qualitative analysis comprised a total of 18 studies (14 retrospective and 4 prospective studies) involving 59,838 patients. IBD was associated with subtle systolic and diastolic alterations, vascular dysfunction, increased risk for HF hospitalizations, and globally worse CV outcomes. Nine studies were included in the meta-analysis. In the IBD population, we found statistically significant reduced early to late diastolic transmitral flow (E/A), higher E to early diastolic mitral annular tissue velocity (E/e'), and decreased global longitudinal strain. Increased left atrial diameter and area were also present in IBD patients but no statistical significance was reached. Inter-atrial and right intra-atrial conduction delays were observed.
Conclusion: The IBD population has an increased risk for left ventricular and atrial dysfunction, vascular changes, arrhythmias, and HF hospitalization. Screening with sensitive imaging like speckle tracking echocardiography could identify early subclinical changes. IBD is in fact a CV risk factor and tight inflammation control may reduce CV risk.
Keywords: cardiovascular risk; inflammation; inflammatory bowel disease.
Inflammatory bowel disease and cardiac function: What you need to know Background and context: The risk of cardiovascular events is higher in patients with inflammatory bowel disease and has a multifactorial etiology. New findings: Subclinical echocardiographic alterations are, to some extent, linked to the activity of the disease. Limitations: Small sample size, observational nature and intra and inter study heterogeneity (which may exist due to differences between group characteristics and echocardiographic study protocols between centers, distinct techniques and modes). Clinical research relevance: Echocardiographic evaluation may identify patients with inflammatory bowel disease at higher risk for cardiac events and determine those who might benefit from tighter inflammation control in order to achieve deeper levels of remission and decrease cardiovascular risk. Basic research relevance: Our findings should motivate research toward a deeper understanding of the role of echocardiographic parameters as tools to evaluate systemic inflammation and its potential as new treatment targets. Indeed, improvement on these parameters may suggest deeper levels of remission. Summary: IBD patients present subclinical cardiac alterations correlated with disease activity. Echocardiographic parameters may be used as inflammatory markers and identify those who might benefit from deeper remission levels.
© The Author(s), 2024.