Objectives. The aim of this study is to investigate the effects of coeliac disease on cardiac function in children using conventional transthoracic echocardiography (TTE) and tissue Doppler echocardiography (TDE). Methods. Coeliac disease patients were evaluated in two different groups based on serum endomysial antibody (EmA) titers (EmA (+) and EmA (？)), and the data obtained by conventional and TDE studies were compared between the patient groups and healthy controls. Results. There was no significant difference between EmA (+) and EmA (？) groups in terms of the conventional TTE parameters, including ejection fraction (EF), fractional shortening (FS), and left ventricle end diastolic diameter (LVEDD), that show the left ventricular systolic function ( , , ). TDE showed a significant difference in left ventricle (LV) isovolumic relaxation time (LV IVRT) and LV myocardial performance index (LV MPI) parameters between EmA (+) and EmA (？) patient groups ( ). Conclusion. The measurement of LV MPI and LV IVRT parameters by TDE would be beneficial in early determination of the cardiac involvement and establishing appropriate treatment and followup of patients with coeliac disease as well as in making distinction between EmA (+) and EmA (？) patients. 1. Introduction Coeliac disease (CD) is childhood disorder characterized by malabsorption and steatorrhoea but can also affect adults of any age [1, 2]. Studies have shown that Coeliac disease affects about 1% of European and American children and adults [3, 4]. This disease may present in various forms depending on the age at onset and disease duration and may be silent or remain asymptomatic [5, 6]. Autoimmune myocarditis and idiopathic dilated cardiomyopathy are a well-known cause of significant morbidity and mortality among comorbidities of Coeliac disease [7]. In Coeliac disease, many theories have been proposed to explain the development of cardiomyopathy [8, 9]. One theory suggests that intestinal malabsorption leads to nutritional deficiency, and another theory suggests that abnormalities of intestinal absorption leads to increased intestinal absorption of antigens and infectious agents and thus to activation of immune mechanisms, which eventuates in myocardial damage. Finally, the direct immune response may cause damage to small intestine and myocardium [10]. In one study, gluten-free diet was found to be protective in the development of autoimmune diseases [11]. However, it is controversial whether gluten-free diet prevents the progression once the Coeliac disease has been diagnosed [12]. Tissue Doppler
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