High dose methyprednisolone in patients with acute Immune Thrombocytopenic Purpura (ITP) cardiovascular effects of high dose steroid.

Aim: The cardiovascular effects of high dose steroid such as asymptomatic bradicardia commonly seen in pediatric patients. In our opinion, this effect related to hypertension and/or natriuretic peptides secreted secondary to volume expansion. That?s why, in this study we investigated cardiovascular effects of high dose steroid in patients with acute immune thrombocytopenic purpura (ITP).Material and methods: The study group consisted of 19 children, aging from 0,5 -16 (6,42 ± 4,17 years), diagnosed as acute ITP, being treated with high dose methylprednisolone, without having any cardiac pathology. The control group consisted of 23 children, without having any cardiac or systemic pathology and without any medications given in recently. After clinical evaluation, and blood pressure measurement, all patients evaluated with ECG, echocardiography before treatment, third and 10.th day after the initiation of the treatment. The study group and control group also evaluated at the 3th day of treatment with holter monitorization. The presence of arrhythmia, the heart rhythm, and time domain heart variability were assesed. Serum NT-proBNP (brain natriuretic peptide), Na, Ca, K, Cr, and urinary Na, Ca, K, Cr were measured before treatment and third and 10.th day after the initiation of the treatment.Results: NT-proBNP values statistically significant increasing were observed in the study at the third day of treatment. (p:0,002). The comparison of the 0.day and third day mean heart rate values significantly decreased in the study group (p:0,006). Hypertension was observed in 10 of the patient (52,6 %) at the the third day of treatment. On the 10.th day, hypertension was observed only one patient. An elavation of Na values was observed at the third day but it was not statistically significant. The statistically significant reduction of plasma K was observed comparison at the 3.rd day of treatment (p:0,003). Plasma K levels increased (p:0,007) at the 10 th day of treatmöent. Plasma creatinine values increased at the third day of treatemnt (p:0,045). An increase in mean FeNa values of the third day was observed but it was not statistically significant when compared with the 0.th day values (p:0,083). The 10.th day mean FeNa levels statistically significant increased (p:0,049) when compared with the 0.th day values. In study group mean FeK value increased at the third day but this was not statistically significant when compared with the 0.th day (p:0,295). The 10.th day mean FeK (p:0,014) and Ca/cr levels statistically significant increased (p:0,009) when compared with the third day values.On echocardiographic examinations, left ventricular systolic and diastolic functions of the patient, the inferior vena cava diameters, left ventricular wall thickness and diameters showed no statistically significant difference. Instudy group, statistically higher avlues of E/A ratios (p:0,0001), isovolumetric contraction time (p:0,004) were observed at the third and 10 th day. The study group mean systolic ejection time, mitral E values were significantly lower (p:0,02, p:0,03 respectively) third and 10.th day.On 24 hour ECG monitoring normal sinus rhythm was noted as sinusal rhythm all subjects. There was?nt important rhthm disturbances. The third day average and minimal heart rate values of the patient group were significantly lower (p:0,01, p:0,002). The comparison of the third day mean maximum heart rate values of groups was not statistically significant (p:0,62). The third day mean SDNN, SDANN index SDNN index, RMSSD, PNN50 values of the patient group were significantly higher (p<0,05). The comparison of the maximum QTc mean values of groups was not statistically significant (p:0>0,05). No statistically significant correlation according to the mean heart rate, third day blood pressure increase and NT-proBNP mean values. Statistically significant correlation between the the NT-proBNP and blood pressure (p:0,003). No statistically significant correlation between the echocardiographic measurement and NT-proBNP mean values (p>0,05) except for third day NT-proBNP mean and third day LVIDD/mm2 mean (r:0,530 p:0,020). Holter parameters were compared with NT-proBNP values and the comparison of the SDNN, SDANN index, SDNN index, RMSSD, PNN50, with the mean NT-proBNP values revealed no statistical significance (p>0,05). The comparison of the plasma Na, K, Ca, urinary Ca, urinary Cr with the mean NT-proBNP values revealed no statistical significance (p>0,05).Conclusion: In our study, decreased in heart rate in 3th day of threatment and hypertension were determined. None of the patients were symptomatic, No arrhythmia was observed with the holter studies. The NT-proBNP values significantly inccreased at the 3th day of treatment. Altough there were not correlation between the NT-proBNP and the heart rate, we thought that bradiacardia is related to NT-proBNP which is increased secondary to volum expansion and/or hypertension.