Global left-ventricular function by tissue Doppler imaging in pediatric dialysis patients

Abstract

Cardiovascular abnormalities are observed in most children with end-stage renal disease (ESRD). The aim of this study was evaluation of left-ventricular (LV) myocardial performance using tissue-Doppler imaging (TDI) in patients with ESRD. Twenty-five patients with ESRD and 25 healthy gender- and age-matched control subjects were assessed with conventional M-mode echocardiography, pulsed-wave Doppler (PWD), and TDI. Myocardial Performance Index (MPI) and LV mass index (LVMI) were calculated. MPI and conventional echo-Doppler indices were compared in the ESRD and control groups. Significant differences were present in the mean systolic and diastolic blood pressure (BP) between children with ESRD and healthy children (p = 0.007 and p < 0.001, respectively). The mean LVMI was significantly greater in the patient group (p < 0.001). The tissue-Doppler MPI of patients was significantly higher than that in healthy children (p < 0.001). LVMI was significantly correlated with systolic and diastolic BP. MPI obtained by TDI was significantly correlated with LVMI. Our study confirms that LV dysfunction is present in patients with ESRD and hypertension is an important risk factor.

Assessment of left ventricular function by tissue Doppler echocardiography in pediatric chronic kidney disease

“…[6][7][8][9] Conventional PWD has been widely used to assess LV diastolic function and, in this method, a decrease in the E/A ratio, the index of LV relaxation, indicates diastolic dysfunction. In previous studies, reduced E/A ratios in children on dialysis have often been reported.…”

“…In previous studies, reduced E/A ratios in children on dialysis have often been reported. 7,8,18,19 In addition, Mitsnefes et al 6 determined low E/A ratios in predialysis pediatric patients as well. Whereas, in another studies in CKD patients, E/A ratios were similar to that in healthy children, in contrast to Mitsnefes et al 9, 10 We also did not find any significant difference in E/A ratios between the patient and control groups.…”

“…In accordance with our findings, in other studies, the relatively low E 0 velocities indicating diastolic dysfunction were shown in predialysis and dialysis patients. 6,[8][9][10] E/E 0 ratio by the combination of transmitral flow velocity with annular velocity, another index of diastolic function, evaluates LV myocardial compliance at enddiastole particularly in patients with preserved systolic function. Increased E/E 0 ratios point out elevated filling pressures, and therefore, impaired diastolic function.…”

“…In previous studies, it has been reported that TDI is less influenced by confounding factors, such as heart rate, volume status, sampling site, left atrial pressure and superior to conventional pulsed-wave Doppler echocardiography (cPWD), in detecting early impaired myocardial function. [6][7][8][9][10] The aim of this study is to assess the relation between cardiac risk factors and LV structural/functional abnormalities examined by both cPWD and TDI in pediatric patients with CKD.…”

Early Origins of Cardiovascular Disease in Pediatric Chronic Kidney Disease

“…LVH has been reported in 20-50 percent of children with stage 2-4 CKD [33][34][35] and the prevalence increases over time. [36] The prevalence is even higher in dialysis [37][38][39] and transplant [40][41][42][43] patients, and results are mixed in terms of whether LVH improves with either form of renal replacement therapy. Both concentric and eccentric LVH are commonly described in all stages of CKD.…”