BackgroundCardiac mortality and morbidity remain signi cant in children on chronic hemodialysis (HD). Multiple markers by speckle tracking echocardiography (STE) are predictive of cardiac events in adults, but data in children are limited; ventricular diastolic strain (Ds) and left atrial strain (LAS) have not been reported.The aim of this study was to investigate intradialytic changes in ventricular and atrial function using STE in children. MethodsSecondary analysis of a prospective descriptive study of children with structurally normal hearts and HD vintage > 3 months, using echocardiography performed prior to, during, and after HD. STE was analyzed using GE EchoPAC. Left ventricular (LV) global longitudinal strain (GLS), strain rate (Sr), and mechanical dispersion index (MDI) were calculated as the average from 3 apical views; Ds and Sr were obtained from 4-chamber tracing; LAS and Sr were assessed during atrial contraction, reservoir, and conduit. Intradialytic changes in 2D STE markers of ventricular function and LAS and their association with blood volume (BV) removal and blood pressure (BP) change were studied. ResultsA total of 15 children were enrolled at a median age of 12 years (IQR 8, 16) and median HD vintage of 13 months (IQR 9, 25). GLS was impaired during HD (-15.8 ± 2.2% vs -19.9 ± 1.9%, p < 0.001). Post-HD GLS was associated mean BP decrease (coe cient = 0.62, p = 0.01) and not with BV removal (coe cient = 0.49, p = 0.06). LV MDI and systolic Sr did not change. LV Ds was progressively impaired (-8.4% (-9.2, -8.0) vs − 11.9% (-13.4, -10.3), p < 0.001). LAS conduit and reservoir worsened at mid-HD and returned to baseline post-HD. Changes in Ds, DSr, LAS, LASr were not associated with BV removal or BP decrease (p > 0.1). ConclusionsIntradialytic LV strain and LAS impairment consistent with subclinical systolic and diastolic dysfunction were observed during HD in children. GLS impairment was associated with BP change, but changes in Ds, DSr, LAS, and LASr were not associated with BP change or BV removal. Longitudinal assessment using these novel non-invasive indices may unfold the effect of cumulative subclinical changes on long-term outcomes in children who are on chronic HD.

ImportanceData are limited regarding adverse reactions after COVID-19 vaccination in patients with a history of multisystem inflammatory syndrome in children (MIS-C). The lack of vaccine safety data in this unique population may cause hesitancy and concern for many families and health care professionals.ObjectiveTo describe adverse reactions following COVID-19 vaccination in patients with a history of MIS-C.Design, Setting, and ParticipantsIn this multicenter cross-sectional study including 22 North American centers participating in a National Heart, Lung, and Blood Institute, National Institutes of Health–sponsored study, Long-Term Outcomes After the Multisystem Inflammatory Syndrome in Children (MUSIC), patients with a prior diagnosis of MIS-C who were eligible for COVID-19 vaccination (age ≥5 years; ≥90 days after MIS-C diagnosis) were surveyed between December 13, 2021, and February 18, 2022, regarding COVID-19 vaccination status and adverse reactions.ExposuresCOVID-19 vaccination after MIS-C diagnosis.Main Outcomes and MeasuresThe main outcome was adverse reactions following COVID-19 vaccination. Comparisons were made using the Wilcoxon rank sum test for continuous variables and the χ2 or Fisher exact test for categorical variables.ResultsOf 385 vaccine-eligible patients who were surveyed, 185 (48.1%) received at least 1 vaccine dose; 136 of the vaccinated patients (73.5%) were male, and the median age was 12.2 years (IQR, 9.5-14.7 years). Among vaccinated patients, 1 (0.5%) identified as American Indian/Alaska Native, non-Hispanic; 9 (4.9%) as Asian, non-Hispanic; 45 (24.3%) as Black, non-Hispanic; 59 (31.9%) as Hispanic or Latino; 53 (28.6%) as White, non-Hispanic; 2 (1.1%) as multiracial, non-Hispanic; and 2 (1.1%) as other, non-Hispanic; 14 (7.6%) had unknown or undeclared race and ethnicity. The median time from MIS-C diagnosis to first vaccine dose was 9.0 months (IQR, 5.1-11.9 months); 31 patients (16.8%) received 1 dose, 142 (76.8%) received 2 doses, and 12 (6.5%) received 3 doses. Almost all patients received the BNT162b2 vaccine (347 of 351 vaccine doses [98.9%]). Minor adverse reactions were observed in 90 patients (48.6%) and were most often arm soreness (62 patients [33.5%]) and/or fatigue (32 [17.3%]). In 32 patients (17.3%), adverse reactions were treated with medications, most commonly acetaminophen (21 patients [11.4%]) or ibuprofen (11 [5.9%]). Four patients (2.2%) sought medical evaluation, but none required testing or hospitalization. There were no patients with any serious adverse events, including myocarditis or recurrence of MIS-C.Conclusions and RelevanceIn this cross-sectional study of patients with a history of MIS-C, no serious adverse events were reported after COVID-19 vaccination. These findings suggest that the safety profile of COVID-19 vaccination administered at least 90 days following MIS-C diagnosis appears to be similar to that in the general population.

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Purpose We aimed to investigate intradialytic changes in ventricular and atrial function using speckle tracking echocardiography (STE) in pediatric hemodialysis (HD). Methods Children with HD vintage > 3 months were enrolled, and echocardiography was performed prior to, during, and after HD. STE was analyzed using GE EchoPAC. Left ventricular (LV) global longitudinal strain (GLS), strain rate (Sr), and mechanical dispersion index (MDI) were calculated as the average from 3 apical views; diastolic strain (Ds) and Sr from 4-chamber tracing; left atrial strain (LAS) and Sr from the 4- and 2-chamber views. Results A total of 15 patients were enrolled at a median age of 12 years (IQR 8, 16) and median HD vintage of 13 months (IQR 9, 25). GLS worsened during HD (-15.8 ± 2.2% vs -19.9 ± 1.9%, p < 0.001). Post-HD GLS was associated with BP decrease (coefficient = 0.62, p = 0.01). LV MDI and systolic Sr did not change. LV Ds progressively worsened (-8.4% (-9.2, -8.0) vs − 11.9% (-13.4, -10.3), p < 0.001). LAS changes at mid-HD returned to baseline post-HD. Ds, DSr, LAS, LASr were not associated with BV removal or BP decrease (p > 0.1). Conclusions Intradialytic LV strain and LAS changes consistent with subclinical systolic and diastolic dysfunction were observed during HD in children. Changes in Ds, DSr, LAS, and LASr were not associated with BP change or BV removal and may be related to the disease progression. Longitudinal study using these novel indices may unfold the effect of these subclinical changes on long-term cardiovascular health in children requiring chronic HD.