A comprehensive characterization of myocardial and vascular phenotype in pediatric chronic kidney disease using cardiovascular magnetic resonance imaging

Abstract

BackgroundChildren with chronic kidney disease (CKD) have increased cardiovascular mortality. Identifying high-risk children who may benefit from further therapeutic intervention is difficult as cardiovascular abnormalities are subtle. Although transthoracic echocardiography may be used to detect sub-clinical abnormalities, it has well-known problems with reproducibility that limit its ability to accurately detect these changes. Cardiovascular magnetic resonance (CMR) is the reference standard method for assessing blood flow, cardiac structure and function. Furthermore, recent innovations enable the assessment of radial and longitudinal myocardial velocity, such that detection of sub-clinical changes is now possible. Thus, CMR may be ideal for cardiovascular assessment in pediatric CKD. This study aims to comprehensively assess cardiovascular function in pediatric CKD using CMR and determine its relationship with CKD severity.MethodsA total of 120 children (40 mild, 40 moderate, 20 severe pre-dialysis CKD subjects and 20 healthy controls) underwent CMR with non-invasive blood pressure (BP) measurements. Cardiovascular parameters measured included systemic vascular resistance (SVR), total arterial compliance (TAC), left ventricular (LV) structure, ejection fraction (EF), cardiac timings, radial and longitudinal systolic and diastolic myocardial velocities. Between group comparisons and regression modelling were used to identify abnormalities in CKD and determine the effects of renal severity on myocardial function.ResultsThe elevation in mean BP in CKD was accompanied by significantly increased afterload (SVR), without evidence of arterial stiffness (TAC) or increased fluid overload. Left ventricular volumes and global function were not abnormal in CKD. However, there was evidence of LV remodelling, prolongation of isovolumic relaxation time and reduced systolic and diastolic myocardial velocities.ConclusionAbnormal cardiovascular function is evident in pre-dialysis pediatric CKD. Novel CMR biomarkers may be useful for the detection of subtle abnormalities in this population. Further studies are needed to determine to prognostic value of these biomarkers.Electronic supplementary materialThe online version of this article (10.1186/s12968-018-0444-0) contains supplementary material, which is available to authorized users.

The cardiovascular phenotype of childhood hypertension: a cardiac magnetic resonance study

“…Specifically, the renal patients had higher diastolic blood pressure and mean blood pressure, while the essential hypertension group had greater pulse pressure. These findings are in keeping with previous large studies of blood pressure in these populations [5, 19] and suggest differing vascular abnormalities. However, it is not possible to definitively characterize vascular phenotype using this information because of the important role of cardiac output in determining blood pressure.…”

“…The renal group was a subset of a previously examined group of pediatric chronic kidney disease patients who had been phenotyped using MRI [5]. Only renal patients with a confirmed diagnosis of hypertension were included in this study.…”

“…Recently, cardiovascular magnetic resonance imaging (MRI) has been combined with noninvasive pressure measurements to accurately evaluate vascular function in children. Using this technique, it has been shown that children with renal disease have raised systemic vascular resistance compared to healthy children [5]. We believe this approach could be used to explore different vascular phenotypes in pediatric hypertension.…”

Journal of Cardiovascular Magnetic Resonance: 2017/2018 in review

“…Children with chronic kidney disease (CKD) have increased cardiovascular mortality. In this pediatric study of 120 children with mild, moderate and severe CKD, Cheang et al [182] found CMR evidence for LV remodeling and reduced systolic and diastolic myocardial velocities in the CKD population. They hypothesized that novel CMR biomarkers may be useful in the early detection of abnormalities in this population.…”

Left Ventricular Myocardial Deformations in Hemodialysis Children by Speckle Tracking Echocardiography

“…10 The systolic left ventricular (LV ) function generally seems to be well preserved in children with ESRD as reported in previous studies with the use of 2-dimensional (2D) echocardiography and tissue Doppler measurements. [6][7][8][9]11,12 Speckle tracking echocardiography (STE) permits the evaluation of myocardial mechanics and eventually myocardial deformation. [13][14][15] Speckle tracking echocardiography allows the study of myocardial speed and movement at more than 1 point at the same time.…”