Systolic and Diastolic Ventricular Function Assessed by Tissue Doppler Imaging in Children with Chronic Kidney Disease

Abstract

Chronic kidney disease (CKD) is associated with elevated cardiovascular risk even during childhood. Tissue Doppler is a sensitive technique for the assessment of ventricular dysfunction with relatively little data available in children with CKD. We report a prospective cross-sectional echocardiographic study at a tertiary center. Forty-nine patients with median (range) age 11.2 years (6.9-17.9), weight 39.6 kg (23.6-99.7) and height 146 cm (122-185). Thirty-one patients were male. Median duration of follow-up for CKD was 7.1 years (range 0.13-16.9). Patients were in CKD stage 3 (n = 37) or 4 (n = 12). Mitral valve E-wave, A-wave, and E/A ratio showed mean (SD) z-scores of 0.08 (0.93), 0.12 (0.82) and -0.13 (0.84), respectively. Tissue Doppler imaging (TDI) at the lateral mitral valve annulus showed e', a', s', and E/e' z-scores mean (SD) -1.10 (0.76), -0.29 (0.92), -1.2 (0.7), and 0.86 (1.1), respectively. There was a significant negative correlation of e' and s' z-score with patient age. E/e' ratio correlated positively with patient age. Blood pressure, left ventricular mass, and relative wall thickness did not correlate with tissue Doppler measurements. The e' and s' velocities correlated significantly with each other, suggesting an interaction of systolic and diastolic dysfunction. Children with CKD may have abnormalities of systolic and diastolic ventricular function on TDI, which are not evident on blood pool Doppler. The tissue Doppler results are consistent with worsening ventricular function in older patients.

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

“…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. However, cPWD is influenced by several factors, such as preload and left atrial pressure, and this may explain the controversial results related to the E/A ratios in patients with CKD.…”

“…In another study, 26 although predialysis and dialysis patients had increased LV mass, LV performance and contractility at rest, it was shown that contractile reserve diminished during exercise in the cohort of dialysis. Simpson et al 10 determined that S 0 values were reduced compared with normal, and negatively correlated with patient age. In their study, they used age specific z-scores of measurements because raw TDI values were influenced by patient age, whereas, Lindblad et al 9 observed that S 0 values were not significantly different between reference and predialysis patients.…”

“…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 their study, they did not find any association between age and E/ E 0 . Simpson et al 10 determined an age-related increase in E/ E 0 z-scores in predialysis patients, and they thought that this increase may not have major clinical relevance in childhood but might be an early indication of diastolic dysfunction in later life. Lindblad et al 9 observed significantly higher E/E 0 ratio in predialysis patients and a young age correlated with an increased E/E 0 .…”

“…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.…”