MYOCARDIAL DYSFUNCTION AND CONNECTIVE TISSUE DYSPLASIA AS PREDICTORS OF BRONCHIAL ASTHMA SEVERITY IN CHILDREN: RESULTS OF A COHORT COMPARATIVE STUDY

Resume. On a global scale, bronchial asthma (BA) ranks 16th in impact on the life expectancy of individuals with disabilities and remains the most common chronic disease of childhood. Modern views consider BA as a risk factor for cardiovascular pathology due to recurrent hypoxemia, systemic inflammation, and the impact of long-term maintenance therapy. Investigating subclinical myocardial dysfunction is crucial for optimizing personalized management of pediatric patients.Objective: to investigate electrocardiographic and ultrasonographic morphometric indicators of myocardial dysfunction in children with bronchial asthma of varying severity to optimize precision approaches in disease management.Material and Methods. A cohort of 75 children with BA (disease duration >2 years) was examined. Patients were divided into two groups: Group I (n=37) — children with mild persistent asthma; Group II (n=38) — patients with moderate-to-severe asthma. Asthma control (ACT-test), body mass index (BMI), and comorbid conditions were evaluated. Diagnostic tools included electrocardiography (ECG) and echocardiography (Echo-CG) assessing left ventricular parameters (LVDd, LVPWd, IVSd, FS) and valvular apparatus.Results. It was established that mild persistent BA associated with better symptom control under low-dose inhaled corticosteroids (OR=6.4; 95% CI: 3.06-13.4). Group II patients more frequently exhibited allergic rhinitis (42.1% vs 29.73% in Group I; OR=1.92) and overweight (26.32%). ECG findings showed no significant differences in the electric axis position; however, T-wave inversion was 1.55 times more frequent in Group II (27.27%). Echo-CG data revealed that children with moderate-to-severe asthma significantly more often had a combination of mitral and tricuspid valve prolapse (OR=3.7; 95% CI: 1.86-7.2). Morphometric parameters of the left ventricle (LVPWd, IVSd) in Group II showed a tendency toward increase. Given the absence of acute inflammation (normal levels of CRP and ASLO) and hypertrophy, these changes suggest the role of connective tissue dysplasia in the formation of biventricular dysfunction.Conclusions. Mild persistent bronchial asthma in school-age children is associated with superior symptom control using low-dose inhaled corticosteroids, lower comorbidity, and better ECG results compared to severe forms. Children with moderate-to-severe asthma have higher odds of comorbid atopic diseases (OR=1.92), specifically allergic rhinitis (OR=1.7). One in four patients (26.32%) is overweight, and 40.0% exhibit combined mitral and tricuspid valve prolapse (OR=3.7 compared to Group I). The biventricular combination of valvular prolapse alongside deviations in left ventricular diastolic markers suggests underlying connective tissue dysplasia in children with moderate-to-severe asthma, which contributes to increased cardiac load and requires consideration in personalized treatment strategies.