Liver: The liver T2* value will be determined as follows: a single transaxial 10 mm slice through the centre of the liver will

be scanned at a series of 14 different echo times (0.94–17.58 ms, which will increase in 1.28 ms increments), using a multiecho gradient-echo sequence with a flip angle of 20°, a matrix of 128–128 pixels, a field of view of 40 cm and a sampling bandwidth of 1502 Hz per pixel. Both this even and odd echoes will be used. The TR between two radio frequency pulses will be 200 ms, with no cardiac gating. In the liver, a large ROI will be chosen in a homogeneous area of the liver parenchyma without blood vessels. Analysis will then be performed as described for the heart multiecho. Echocardiography indices A detailed paediatric echocardiography will be performed to rule out any undiagnosed structural heart disease. This will be performed in the paediatric cardiology echocardiography unit, according to standard protocol using Philips IE33 or GE 9 machine with a 5–12 MHz phased array transducer. The following measurements will be

observed: LV volume and systolic function: LV volumes and EF will be obtained from apical 4 chamber and short axis views using the 5/6×area×length method.37 These values will be compared to anthropometric based z-scores. Diastolic function: Mitral and tricuspid E and A waves, mitral and tricuspid E/A ratios, mitral lateral and septal E′ tricuspid E′ and E/E′ ratios. Speckle tracking Longitudinal speckle tracking imaging derived strain peak (in %) will be obtained using the software offline package (TomTec Imaging Systems, Inc, Unterschleissheim, Germany) by tracing images obtained from the apical 4 chamber view (figure 3). Using the speckle-tracking algorithm, the package tracks a total of 49 points (ie, speckles) along the ventricular wall and interventricular septum (IVS). The ventricle is then divided into six segments, three along the free wall (basal, mid and apical free wall) and three along the IVS (basal, mid and apical septum), and the average of the speckles in the respective segments is displayed as the peak longitudinal

strain for that segment. We will also calculate the mean peak longitudinal strain for the right ventricular (RV) and LV lateral free walls and IVS as an average of the three segmental values (base, mid and apex). The package also reports a global longitudinal strain peak for RV and LV. Since longitudinal fibres shorten during systole, longitudinal Anacetrapib strain is reported as a negative value. Higher negative values reflect larger deformation. Figure 3 Sample showing ventricular strain assessment using speckle tracking. LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle. Time to peak longitudinal strain (ms) will be calculated for three segments each on the LV free wall, IVS and RV free wall. Values for the three segments will be averaged to calculate the average time to peak strain for each wall (figure 3).