Diastolic dysfunction measured by tissue Doppler imaging in children with end-stage renal disease: a report of the RICH-Q study

Schoenmaker, Nikki J.; Kuipers, Irene M.; Lee, Johanna H. van der; Tromp, Wilma F.; Dyck, Maria Van; Gewillig, Marc; Blom, Nico A.; Groothoff, Jaap W.

doi:10.1017/s1047951113000188

Cited by 16 publications

(16 citation statements)

References 32 publications

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“…In hypertensive patients, diastolic dysfunction precedes systolic function [ 28 ], and this has been described previously in pediatric ESRD [ 10 , 29 , 30 ]. We found decreased e′-velocities, suggestive of reduced early relaxation and increased E/e′ ratio which could indicate higher filling pressures in the patients.…”

Section: Discussionmentioning

confidence: 86%

Impaired longitudinal deformation measured by speckle-tracking echocardiography in children with end-stage renal disease

et al. 2016

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BackgroundLeft ventricular dysfunction is an important co-morbidity of end-stage renal disease (ESRD) and is associated with a poor prognosis in the adult population. In pediatric ESRD, left ventricular function is generally well preserved, but limited information is available on early changes in myocardial function. The aim of this study was to investigate myocardial mechanics in pediatric patients with ESRD using speckle-tracking echocardiography (STE).MethodsEchocardiographic studies, including M-mode, tissue Doppler imaging (TDI) and STE, were performed in 19 children on dialysis, 17 transplant patients and 33 age-matched controls. Strain measurements were performed from the apical four-chamber and the short axis view, respectively.ResultsThe interventricular and left ventricular posterior wall thickness was significantly increased in dialysis and transplant patients compared to healthy controls. No significant differences were found in shortening fraction, ejection fraction and systolic tissue Doppler velocities. Dialysis and transplant patients had a decreased mean longitudinal strain compared to healthy controls, with a mean difference of 3.1 [95 % confidence interval (CI) 2.0–4.4] and 2.7 (95 % CI 1.2–4.2), respectively. No differences were found for radial and circumferential strain.ConclusionsSpeckle-tracking echocardiography may reveal early myocardial dysfunction in the absence of systolic dysfunction measured by conventional ultrasound or TDI in children with ESRD.

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Section: Discussionmentioning

confidence: 86%

Impaired longitudinal deformation measured by speckle-tracking echocardiography in children with end-stage renal disease

et al. 2016

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“…Early disclosure of longitudinal strain impairment may help the physician to recognize high-risk patients with future unfavorable cardiovascular situations. Diastolic dysfunction usually occurs before systolic function in hypertensive patients, 37 and this has been previously reported in pediatric ESRD. 8,35 The diastolic dysfunction could be linked to volume status or declare the lowered LV compliance or may be due to an inflammatory response induced by uremic toxins or be linked to the maladaptive hypertrophic response that happened to these particular patients.…”

Section: Discussionmentioning

confidence: 67%

Left Ventricular Myocardial Deformations in Hemodialysis Children by Speckle Tracking Echocardiography

Elshamaa

Mostafa

Sad

et al. 2020

Clin Med Insights Cardiol

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Background: Cardiac systolic dysfunction was potentially found in adult patients with end-stage renal disease (ESRD) who have preserved left ventricular ejection fraction (EF%). In children with ESRD, little data are available on early changes in myocardial function. This study aimed to detect the early changes in myocardial mechanics in pediatric patients with ESRD using speckle tracking echocardiography (STE). Methods: Thirty ESRD children receiving hemodialysis (HD) and30 age-matched controls were prospectively studied. Patients underwent echocardiographic studies before and after HD. Left ventricular longitudinal strain (LS), circumferential strain (CS), and radial strain (RS) myocardial deformation parameters (strain, strain rate) were evaluated by STE. Results: The LS was significantly reduced in pre-HD and post-HD patients compared with controls ( P = .000). Controls showed the highest global longitudinal strain. The RS measurements did not differ significantly among the studied groups except for the inferior segment that is significantly reduced after HD compared with controls ( P < .05). The CS was significantly reduced in pre-HD and post-HD patients compared with controls at the lateral and posterior segments ( P = .035 and P = .013, respectively). Conclusion: Speckle-tracking echocardiography might detect early changes in myocardial mechanics in children with ESRD with preserved EF%.

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“…In previous small-sample studies in children with CKD variable Doppler indices such as tissue Doppler E’ 16 , E’/A’ 13,14 or conventional pulse wave Doppler E/A 22 were found to be reduced. While an association of diastolic function to serum Cystatin C levels has been shown 23 , no relationship to eGFR has been demonstrated.…”

Section: Discussionmentioning

confidence: 76%

“…Notably, the association appeared to be specific for RAS blockers whereas the use of other antihypertensive agents, including diuretics, did not show any relationship with E/E’ Z-Score. Previous studies in pediatric CKD failed to show associations of LV filling pressure (E/E’) with antihypertensive treatment protocols, possibly due to insufficient sample size or lacking adjustment of Doppler measurements for patient age 14,16,22,26 . We therefore hypothesize that RAS blockade should be the preferred treatment for hypertension in children with CKD independent of the level of proteinuria.…”

Section: Discussionmentioning

confidence: 99%

Impaired Systolic and Diastolic Left Ventricular Function in Children with Chronic Kidney Disease - Results from the 4C Study

Doyon

Haas

Erdem

et al. 2019

Sci Rep

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Children with chronic kidney disease suffer from excessive cardiovascular mortality and early alterations of the cardiovascular system. Tissue doppler imaging is a validated echocardiographic tool to assess early systolic and diastolic cardiac dysfunction. We hypothesized that tissue Doppler velocities would reveal reduced cardiac function in children with chronic kidney disease compared to healthy children. A standardized echocardiographic exam was performed in 128 patients of the Cardiovascular Comorbidity in Children with Chronic Kidney Disease (4C) Study aged 6–17 years with an estimated glomerular filtration rate (eGFR) below 60 ml/min/1.73 m 2 . Tissue Doppler measurements included early (E’) and late (A’) diastolic and systolic (S’) velocity at the mitral and septal annulus of the left ventricle. Measured values were normalized to z-scores using published reference data. Predictors of E’/A’, E/E’, S’ and left ventricular mass index (LVMI) were assessed by multiple linear regression analyses. Tissue Doppler E’ was reduced and tissue Doppler A’ increased, resulting in a reduced tissue Doppler E’/A’ ratio (z-score −0.14, p < 0.0001) indicating reduced diastolic function compared to healthy children. Reduced tissue Doppler E’/A’ Z-Scores were independently associated with lower eGFR (p = 0.002) and increased systolic blood pressure (p = 0.02). While E/E’ Z-Scores were increased (Z-score 0.57, p < 0.0001), patients treated with pharmacological RAS blockade but not with other antihypertensive treatments had significantly lower E/E’ and higher E’/A’ Z-Scores. Systolic tissue Doppler velocities were significantly decreased (Z-score −0.24, p = 0.001) and inversely correlated with E/E’ Z-Scores (r = −0.41, p < 0.0001). LVMI was not associated with systolic or diastolic tissue Doppler velocities. Concentric left ventricular hypertrophy showed a tendency to lower S’ in multivariate analysis (p = 0.13) but no association to diastolic function. Concentric left ventricular geometry was significantly associated with lower midwall fractional shortening. In summary, systolic and diastolic function assessed by tissue Doppler is impaired. eGFR, systolic blood pressure and the type of antihypertensive medications are significant predictors of diastolic function in children with CKD. Left ventricular morphology is largely independent of tissue Doppler velocities. Tissue Doppler velocities provide sensitive information about early left ventricular dysfunction in this population.

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Diastolic dysfunction measured by tissue Doppler imaging in children with end-stage renal disease: a report of the RICH-Q study

Abstract: Tissue Doppler imaging is a more sensitive and reliable method to detect diastolic dysfunction than conventional E/a ratio in children with end-stage renal disease.

Cited by 16 publications

References 32 publications

Impaired longitudinal deformation measured by speckle-tracking echocardiography in children with end-stage renal disease

Impaired longitudinal deformation measured by speckle-tracking echocardiography in children with end-stage renal disease

Left Ventricular Myocardial Deformations in Hemodialysis Children by Speckle Tracking Echocardiography

Impaired Systolic and Diastolic Left Ventricular Function in Children with Chronic Kidney Disease - Results from the 4C Study

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