Left ventricular function in children and adults after renal transplantation in childhood

Hirth, Asle; Edwards, Nicola C.; Greve, Gottfried; Tangeraas, Trine; Gerdts, Eva; Lenes, Kjetil; Norgård, Gunnar

doi:10.1007/s00467-012-2167-z

Cited by 15 publications

(22 citation statements)

References 92 publications

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“…7,8,10-13,16-19,21,22,28-34,36-38,40,42,43,48 (There were four datasets that reported both the GLS and the LS from the apical 4-chamber view only. 19,28,30,33 ) The normal mean values of LS varied from -15.1% to -24.8% (mean -20.4, 95% CI -19.8% to -21.7%), (Figure 2b).…”

Section: Resultsmentioning

confidence: 99%

“…Takayasu et al generated strain measures in two separate cohorts of children and adolescents. 17 The breakdown of the age distribution for the remaining 38 datasets was: four data-sets recruited patients 0-1 years of age, 30,36,37,47 18 datasets had patients with age ranges of 2 and 9 years of age, 7,10,12,13,15,18,22,26,29,31,34,35,39,40,42,43,48 10 datasets had patients with age ranges of 10 and 13 years of age, 9,14,19-21,25,27,32,41,46 6 datasets examined patients with age ranges 14-21 years of age. 11,23,24,28,38,44 We performed a separate meta analysis for LV strain measures stratified by age distribution using the mean age from each study as a continuous variable and also by categorizing each study into one of the four age distribution categories, 0-1, 2-9, 10-13, and 14-21 (Figures 2-4).…”

Section: Resultsmentioning

confidence: 99%

“…Less than 25% of the eligible studies recorded these strain rate indices and most authors could not demonstrate significant reliability. 22 There is still a paucity of studies that used radial or circumferential strain rate measurements in clinical practice to measure LV function in children. Furthermore, this meta-analysis showed that some of the ranges for CS and RS are wide and should be used with caution.…”

Section: Discussionmentioning

confidence: 99%

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Reference Ranges of Left Ventricular Strain Measures by Two-Dimensional Speckle-Tracking Echocardiography in Children: A Systematic Review and Meta-Analysis

Levy

Machefsky

Sanchez

et al. 2016

Journal of the American Society of Echocardiography

268

215

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Background The establishment of the range of reference values and associated variations of two-dimensional speckle-tracking echocardiography (2DSTE) derived left ventricular (LV) strain is a prerequisite for its routine clinical adoption in pediatrics. The aims were to perform a meta-analysis of normal ranges of LV global longitudinal, circumferential, and radial strain (GLS, GCS, and GRS) measurements derived by 2DSTE in children and identify confounding factors that may contribute to variances in reported measures. Methods A systematic review was launched in Medline, Embase, Scopus, CINAHL, and Cochrane. Search hedges were created to cover the concepts of pediatrics, speckle-tracking echocardiography, and left heart ventricle. Two investigators independently identified and included studies if they reported the 2DSTE derived LV GLS, GCS or GRS. The weighted mean was estimated by using random-effects with 95% confidence interval (CI), heterogeneity was assessed by the Cochran's Q statistic and the inconsistency index (I2) and publication was evaluated using the Egger test. Effects of demographic (age), clinical, and vendor variables were assessed in a meta-regression. Results The search identified 2325 children from 43 data sets. The reported normal mean values of GLS among the studies varied from -16.7% to -23.6% (mean -20.2%, 95% CI -19.5% to -20.8%), GCS varied from -12.9% to -31.4% (mean -22.3%, 95% CI -19.9% to -24.6%) and GRS, varied from 33.9% to 54.5 % (mean 45.2 95% CI 38.3 to 51.7). 26 studies reported LS only from the apical 4-chamber view with a mean of -20.4%, (95% CI -19.8% to -21.7%). 23 studies reported CS (mean, -20.3%, 95% CI -19.4% to -21.2%) and RS (mean, 46.7%, 95% CI 42.3% to 51.1%) from the short axis view at the mid-ventricular level. A significant apex-to-base segmental longitudinal strain (SLS) gradient (P < .01) was observed in the LV free wall. There was significant between- study heterogeneity and inconsistency (I2 > 94% and P < .001 for each strain measure), which was not explained by age, gender, body surface area, blood pressure, heart rate, frame rate, FR/HR ratio tissue-tracking methodology, location of reported strain value along the strain curve, ultrasound equipment, or software. These metaregression showed that these effects were not significant determinants of variations among normal ranges of strain values. There was no evidence of publication bias (P = .40). Conclusions This study defined reference values of 2DSTE derived LV strain in children on the basis of a meta-analysis. In healthy children, the mean LV global longitudinal strain value is -20.2%, (95% CI -19.5% to -20.8%), mean global circumferential strain -22.3%, (95% CI -19.9% to -24.6%), and mean global radial strain is 45.2%, (95% CI 38.3% to 51.7%). LV segmental longitudinal strain has a stable apex-to-base gradient that is preserved throughout maturations. Although variations among different reference ranges in this meta-analysis were not dependent on differences in demographic, clinical, or vendor para...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Reference Ranges of Left Ventricular Strain Measures by Two-Dimensional Speckle-Tracking Echocardiography in Children: A Systematic Review and Meta-Analysis

Levy

Machefsky

Sanchez

et al. 2016

Journal of the American Society of Echocardiography

268

215

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“…Hypertension, anemia, malnutrition, obesity, hyperparathyroidism, dyslipidemia, and type 2 diabetes mellitus are important determinants of left ventricular structure. [5][6][7][8][9]17 Systolic hypertension is a major determinant of left ventricle geometry, especially concentric changes (remodeling and hypertrophy), after renal transplant. 8,17,[19][20][21] In our study group, the indexes of systolic blood pressure before transplant were within normal limits, with parameters showing, although insignificant, a trend toward further improvement during the 6 months after transplant (P = .…”

Section: Discussionmentioning

confidence: 99%

“…Deteriorated graft function, hypertension, hyperlipidemia, obesity, type 2 diabetes mellitus, anemia, and malnutrition are all the determinants of cardiovascular disease in these children. [5][6][7][8][9] Although these risk factors are well known in adults, studies that have evaluated systolic cardiac dysfunction and associated risk factors in pediatric kidney recipients are still limited. Therefore, we wanted to assess the systolic functions and related risk factors in children within the first 6 months after kidney transplant.…”

Section: Introductionmentioning

confidence: 99%

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Alparslan

Yavaşcan²,

Ms³

et al. 2017

Exp Clin Transplant

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Objectives: In this study, our aim was to evaluate the systolic cardiac parameters and related risk factors in children within 6 months after kidney transplant. Materials and Methods: We retrospectively evalua ted 24 children who received kidney transplants. Clinical and laboratory parameters before and after transp lant were recorded. Results were evaluated statis tically, with a P value less than .05 considered significant. Results: Before transplant, systolic cardiac functions were within normal limits. After transplant, ejection fraction (63.35% ± 5.38% vs 66.95% ± 4.62%; P = .01) was significantly increased and left ventricular mass index (32.63 ± 17.21 g/m 2.7 vs 31.29 ± 15.65 g/m 2.7 ; P = .78) was not significantly decreased, whereas fractional shortening (52.16% ± 15.32% vs 59.8% ± 12.94%; P = .54) did not change. Systolic blood pressure, systolic blood pressure index, diastolic blood pressure, and diastolic blood pressure index values were not statistically different before and after transplant (P > .05). The number of anti hypertensive agents was significantly decreased (P = .001). Before and after transplant, cardiac geometry was normal in 15 patients (62.5%) and 17 patients (70.8%). Conclusions: Our patients, who had stable systolic cardiac function before transplant, showed furt her improvements in systolic cardiac function even within 6 months after transplant. Therefore, strictly monitored and controlled blood pressure, volume, anemia, and nutrition in children before transplant may play important roles in achieving better cardiac systolic function after kidney transplant.

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Subclinical cardiac dysfunction in pediatric kidney transplant recipients identified by speckle-tracking echocardiography

et al. 2022

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Background Kidney transplantation (KTx) improves prognosis in children with kidney failure; still, these patients are prone to cardiovascular damage due to multiple risk factors. Our aim was to assess myocardial structure and function in pediatric KTx by conventional and speckle-tracking echocardiography (STE) in association with established cardiovascular risk factors. Methods Forty-two KTx and 39 healthy age- and gender-matched children were evaluated. KTx recipients were further categorized according to the control of hypertension assessed by 24-h ambulatory blood pressure monitoring (ABPM). Subjects underwent pulse wave velocity (PWV) measurement, conventional echocardiography, and 2-dimensional STE. Left and right ventricular (LV, RV) global longitudinal strain (GLS), and LV circumferential strain (GCS) were measured. Glomerular filtration rate (eGFR) was calculated according to the Schwartz formula. Results KTx patients had increased blood pressure and arterial stiffness. LV ejection fraction (EF) was preserved along with elevated LV mass index (LVMi) while LVGLS was significantly lower, whereas LVGCS and RVGLS were increased in KTx. Uncontrolled hypertensives had lower LVGLS compared to those with controlled hypertension. Using multiple forward stepwise regression analysis, 24-h SBP and relative wall thickness (RWT) were independent determinants of LVMi, whereas antihypertensive therapy, eGFR, and HOMA-IR were independent determinants of LVGLS. Conclusions Cardiac morphology and function show distinct changes after KTx. Along with comparable ventricular volumes, LV hypertrophy and subclinical myocardial dysfunction are present. Control of hypertension and kidney graft function are major factors of LV performance. STE may be useful to reveal early myocardial dysfunction in pediatric KTx. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information.

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Left ventricular function in children and adults after renal transplantation in childhood

Abstract: Patients who underwent renal transplantation in childhood have abnormal LV diastolic function and impaired exercise capacity, despite preserved LV longitudinal systolic deformation.

Cited by 15 publications

References 92 publications

Reference Ranges of Left Ventricular Strain Measures by Two-Dimensional Speckle-Tracking Echocardiography in Children: A Systematic Review and Meta-Analysis

Reference Ranges of Left Ventricular Strain Measures by Two-Dimensional Speckle-Tracking Echocardiography in Children: A Systematic Review and Meta-Analysis

Untitled

Subclinical cardiac dysfunction in pediatric kidney transplant recipients identified by speckle-tracking echocardiography

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