Left ventricular strain and left atrial strain are impaired during hemodialysis in children

Doan, Tam; Srivaths, Poyyapakkam; Liu, Asela; Wilkes, J. Kevin; Idrovo, Alexandra; Akcan-Arikan, Ayse; Swartz, Sarah J.; Geer, Jessica; Altman, Carolyn A.; Ayres, Nancy A.; Loar, Robert W.; Pignatelli, Ricardo H.

doi:10.1007/s10554-021-02350-9

Cited by 11 publications

(7 citation statements)

References 23 publications

(38 reference statements)

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“…The endocardial tracing was automatically generated by the computer algorithm (Q Lab 15, Philips Medical Systems) and manually adjusted when necessary. Global LV peak systolic global longitudinal strain was calculated, representing the average values of the 17 ventricular segments analyzed in the three views 20 .…”

Section: Dst Echocardiogrammentioning

confidence: 99%

Left atrial strain by speckle-tracking: incremental role in diastolic assessment of pediatric patients with chronic kidney disease

Penachio

Laurino

Watanabe

et al. 2022

Preprint

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Background: cardiovascular complications are the leading mortality cause among children with chronic kidney diseases (CKD), being responsible for up to 30% of deaths. Left ventricle (LV) diastolic dysfunction is common and has been linked to poor cardiovascular outcomes. Echocardiographic assessment of diastolic function in CKD children is usually limited to spectral and tissue Doppler imaging, known to be less reliable techniques in pediatrics. Two-dimensional Speckle tracking echocardiography (2DST) evaluation of LA strain has recently been confirmed as a robust measure of diastolic function, in different clinical scenarios. Objectives: to investigate LA strain role in diastolic function assessment of children at different stages of CKD, comparing it with standard echocardiographic parameters. Methods: From February 2019 to July 2022, 55 consecutive pediatric CKD patients without cardiovascular symptoms and 55 healthy volunteers were evaluated by standard and 2DST echocardiograms. Clinical data were collected from medical records by the attendant physician. Results: patients and controls had similar age [9.78 (0.89 – 17.54) years vs. 10.72 (1.03 – 18,44) years; p = 0.41] and gender (36M:19F vs. 34M:21F; p = 0.84). The median duration of the disease was 8.1 (0.83 - 17.5) years. There were 7 (12.8%) CKD stage I, 4 (7.3%) CKD stage II, 12 (21.8%) CKD stage III, 2 (3.6%) CKD stage IV and 30 (54.5%) CKD stage V patients. Standard echo reveled preserved (≥ 55%) LV EF in all of them. Although average E/e’ was higher in CKD [6.99 (4.75 – 14.20) vs. 6.38 (3.88 – 11.11); p = 0.009], it was above normal limits in only one individual. Comparing CKD and controls, LA reservoir strain was lower (48.22 ± 10.62% vs. 58.52 ± 10.70%; p < 0.0001) and LA stiffness index was higher [0.14 (0.08 – 0.48) % vs. 0.11 (0.06 – 0.23) % ; p < 0.0001]. LV hypertrophy was associated with lower LA reservoir strain (42.05 ± 8.74% vs. 52.99 ± 9.52%; p < 0.0001), higher LA stiffness index [0.23 (0.11 – 0.48) % vs. 0.13 (0.08 – 0.23) % ; p < 0.0001) and filling index (2.39 ± 0.63 cm/s x % vs. 1.74 ± 0.47 cm/s x % ; p = 0.0001). Uncontrolled hypertension was associated with lower LA reservoir strain (41.9 ± 10.6% vs. 50.6 ± 9.7; p = 0.005). CKD stage showed negative correlation with LA reservoir strain ( r = - 0.37; p = 0.006) and conduit strain ( r = - 0.28; p = 0.0035), besides positive correlation with LA stiffness index (r = 0.48; p = 0.0002). E/e’ showed inferior accuracy in differentiating CKD patients from controls (AUC = 0.64), when compared with LA reservoir strain (AUC = 0.75) and LA stiffness index (AUC = 0.73). LA reservoir strain showed the best accuracy in differentiating dialysis form non dialysis patients (AUC = 0.77). Conclusions: LA strain parameters, especially reservoir strain and stiffness index, showed better accuracy than conventional E/e’ ratio concerning diastolic evaluation in pediatric CKD population. Since diastolic dysfunction bears strong prognostic value in CKD, incorporation of LA strain in routine echocardiographic evaluation of this particular pediatric population seems to be an appropriate strategy

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Section: Dst Echocardiogrammentioning

confidence: 99%

Left atrial strain by speckle-tracking: incremental role in diastolic assessment of pediatric patients with chronic kidney disease

Penachio

Laurino

Watanabe

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…Inferior vena cava (IVC) parameters along with clinical correlation have been shown to accurately predict fluid status in dialysis patients with adult studies showing improved cardiac mechanics and left ventricular mass (LVM) with dry weights adjusted according to IVC diameter [ 55 ]. Additional data can be derived from echocardiograms performed during dialysis or in the immediate post-dialysis period [ 30 , 56 ] and a number of methods incorporating time have been used to reduce the impact of volume status on echocardiogram measures. An example is the myocardial performance index (MPI), or Tei index.…”

Section: The Natural History Of Cvd In Pediatric Kidney Failurementioning

confidence: 99%

“…In adults stunning has been demonstrated to progress to fixed regional systolic dysfunction and global reduction in LVEF by 12 months [ 31 ] and is associated with 12-month mortality [ 76 ]. Impaired GLS measured by STE has been demonstrated in childhood chronic KF in the absence of conventional echocardiography measures of systolic dysfunction [ 56 ]. In adult dialysis patients, GLS is associated with CV mortality independent of age and conventionally measured EF [ 43 ].…”

Section: The Natural History Of Cvd In Pediatric Kidney Failurementioning

confidence: 99%

“…In adult dialysis patients, GLS is associated with CV mortality independent of age and conventionally measured EF [ 43 ]. The HD population appears to be most at risk, especially if assessed during or immediately following a HD session [ 35 , 47 , 56 , 77 ] and if there are more significant falls in systolic blood pressure or higher ultrafiltration volumes [ 56 , 77 ]. Segmental differences in LV strain can also be seen at this time [ 47 ] including where measured by the asynchrony index (Table 1 ) [ 77 ].…”

Section: The Natural History Of Cvd In Pediatric Kidney Failurementioning

confidence: 99%

“…In HD, left atrial strain (LAS) measures may be an even more sensitive measure of DD and cardiac events [ 82 ]. LAS has recently been demonstrated to worsen during HD in children [ 56 ].…”

Section: The Natural History Of Cvd In Pediatric Kidney Failurementioning

confidence: 99%

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Echocardiogram screening in pediatric dialysis and transplantation

et al. 2022

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Transthoracic echocardiography is commonly used to identify structural and functional cardiac abnormalities that can be prevalent in childhood chronic kidney failure (KF). Left ventricular mass (LVM) increase is most frequently reported and may persist post-kidney transplant especially with hypertension and obesity. While systolic dysfunction is infrequently seen in childhood chronic KF, systolic strain identified by speckle tracking echocardiography has been frequently identified in dialysis and it can also persist post-transplant. Echocardiogram association with long-term outcomes has not been studied in childhood KF but there are many adult studies demonstrating associations between increased LVM, systolic dysfunction, strain, diastolic dysfunction, and cardiovascular events and mortality. There has been limited study of interventions to improve echocardiogram status. In childhood, improved blood pressure has been associated with better LVM, and conversion from hemodialysis to hemodiafiltration has been associated with better diastolic and systolic function. Whether long-term cardiac outcomes are also improved with these interventions is unclear. Echocardiography is a well-established technique, and regular use in childhood chronic KF seems justified. A case can be made to extend screening to include speckle tracking echocardiography and intradialytic studies in high-risk populations. Further longitudinal studies including these newer echocardiogram modalities, interventions, and long-term outcomes would help clarify recommendations for optimal use as a screening tool.

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Plasma FGF23 is associated with left atrial remodeling in children on hemodialysis

Patel

Hanudel

et al. 2022

Pediatr Nephrol

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Left ventricular strain and left atrial strain are impaired during hemodialysis in children

Cited by 11 publications

References 23 publications

Left atrial strain by speckle-tracking: incremental role in diastolic assessment of pediatric patients with chronic kidney disease

Left atrial strain by speckle-tracking: incremental role in diastolic assessment of pediatric patients with chronic kidney disease

Echocardiogram screening in pediatric dialysis and transplantation

Plasma FGF23 is associated with left atrial remodeling in children on hemodialysis

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