P0413Cardiac involvement in children with Inflammatory Bowel Disease: insights from eight Italian tertiary centres

Background Cardiac complications in paediatric inflammatory bowel diseases (PIBD) are poorly characterised. Existing evidence is limited, with the most extensive review to date—published in 2022—reporting 28 cases [1]. The aim of the current study was to describe cardiac involvement in an Italian PIBD cohort. Methods A standardized protocol for reporting PIBD cases with cardiac manifestations was disseminated across tertiary centres affiliated with Italian Society of Paediatric Gastroenterology, Hepatology and Nutrition (SIGENP). Demographic and clinical data were retrospectively collected, including IBD phenotype, disease activity, cardiac manifestations, treatments, and follow-up. Results Data were collected from 8 Italian centres, identifying 18 PIBD patients with cardiac involvement; 7 (39%) had Crohn’s disease (CD) and 11 (61%) ulcerative colitis (UC). Median age at cardiac event was 14 years (IQR 12–14). Patients’ details are summarized in Table 1. Cardiac events included arrhythmias (7/18, 38%; 4 UC, 3 CD), pericarditis (5/18, 27%; 3 CD, 2 UC), myocarditis/myopericarditis (4/18, 22%; all UC), atrial myxoma (1/18, 5%; CD) and valvular insufficiency (1/18, 5%; UC). Cardiac events occurred equally during active disease (9/18, 50%) and clinical remission (9/18, 50%). Eleven out of 18 patients (61%) developed the cardiac event within 1 year of IBD diagnosis, and 14 of 18 (77%) within 2 years. Among the 9 cases of pericarditis and myocarditis, 7 (77%) occurred in patients treated with mesalazine. IBD treatment was modified in 7/18 (39%) patients following the cardiac event, mainly by discontinuation of 5-ASA: 13/18 (72%) patients were receiving 5-ASA at the time of the event, 6 of them stopped it—5 due to pericarditis/myocarditis and 1 due to atrial myxoma. Ten out of 18 (55%) patients required hospitalization, 13/18 (72%) achieved resolution of the cardiac complication. Conclusion Cardiac complications in PIBD are rare but may occur early in the disease course and during both active and quiescent phases. Mesalazine was frequently associated with pericarditis/myocarditis. These findings underscore the need for heightened clinical vigilance and prompt evaluation of any suggestive symptoms. Larger studies are required to clarify potential associations between IBD, IBD therapies, and cardiac manifestations, and to better define incidence and prevalence. Reference: 1. Cesa K, et all. A Review of Extraintestinal Manifestations & Medication-Induced Myocarditis and Pericarditis in Pediatric Inflammatory Bowel Disease. Cureus. 2022 Jun 27;14(6): e26366. Conflict of interest: Dr. Rigotti, Laura: No conflict of interest Silvera, Valentina: No conflict of interest Stella, Giuseppe: No conflict of interest Giorgio, Valentina: No conflict of interest Alvisi, Patrizia: No conflict of interest Illiceto, Maria Teresa: No conflict of interest Bramuzzo, Matteo: No conflict of interest Isoldi, Sara: No conflict of interest Scarallo, Luca: No conflict of interest Faraci, Simona: No conflict of interest Penagini, Francesca: No conflict of interest Gianolio, Laura: No conflict of interest Norsa, Lorenzo: No conflict of interest