Subclinical Cardiac Dysfunction in Pediatric Kidney Transplant Recipients Identified by Speckle-tracking Echocardiography

Overview

Journal Pediatr Nephrol

Specialties Nephrology
Pediatrics

Date 2022 Feb 15

PMID 35166914

Authors

Adrienn Barczi

Balint Karoly Lakatos

Monika Szilagyi

Eva Kis

Orsolya Cseprekal

Alexandra Fabian

Attila Kovacs

Attila J Szabo

Bela Merkely

Paolo Salvi

Gyorgy S Reusz

Affiliations

Soon will be listed here.

Abstract

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. A higher resolution version of the Graphical abstract is available as Supplementary information.

Citing Articles

3D-based strain analysis and cardiotoxicity detection in cancer patients received chemotherapy.

Azzam M, Wasef M, Khalaf H, Al-Habbaa A BMC Cancer. 2023; 23(1):760.

PMID: 37587421 PMC: 10428536. DOI: 10.1186/s12885-023-11261-y.

Decreased ventricular systolic function in chemotherapy-naive patients with acute myeloid leukemia: a three-dimensional speckle-tracking echocardiography study.

Zhang Y, Tan Y, Liu T, Fu Y, Lin Y, Shi J Front Cardiovasc Med. 2023; 10:1140234.

PMID: 37351288 PMC: 10282833. DOI: 10.3389/fcvm.2023.1140234.

Get to the heart of pediatric kidney transplant recipients: Evaluation of left- and right ventricular mechanics by three-dimensional echocardiography.

Ladanyi Z, Barczi A, Fabian A, Ujvari A, Cseprekal O, Kis E Front Cardiovasc Med. 2023; 10:1094765.

PMID: 37008334 PMC: 10063872. DOI: 10.3389/fcvm.2023.1094765.

Changes in myocardial work associated with pediatric kidney transplantation: A pilot study of short-term postoperative effect.

Xiao F, Fan R, Zhang J, Ye M, Li W, Liu D J Clin Hypertens (Greenwich). 2022; 24(12):1547-1557.

PMID: 36367189 PMC: 9731598. DOI: 10.1111/jch.14595.

Atrial Function Impairments after Pediatric Cardiac Surgery Evaluated by STE Analysis.

Cantinotti M, Marchese P, Scalese M, Franchi E, Assanta N, Koestenberger M J Clin Med. 2022; 11(9).

PMID: 35566624 PMC: 9105784. DOI: 10.3390/jcm11092497.

References

Routledge F, McFetridge-Durdle J, Dean C . Night-time blood pressure patterns and target organ damage: a review. Can J Cardiol. 2007; 23(2):132-8. PMC: 2650649. DOI: 10.1016/s0828-282x(07)70733-x. View

Jategaonkar S, Scholtz W, Butz T, Bogunovic N, Faber L, Horstkotte D . Two-dimensional strain and strain rate imaging of the right ventricle in adult patients before and after percutaneous closure of atrial septal defects. Eur J Echocardiogr. 2009; 10(4):499-502. DOI: 10.1093/ejechocard/jen315. View

Fujikura K, Peltzer B, Tiwari N, Shim H, Dinhofer A, Shitole S . Reduced global longitudinal strain is associated with increased risk of cardiovascular events or death after kidney transplant. Int J Cardiol. 2018; 272:323-328. PMC: 6325639. DOI: 10.1016/j.ijcard.2018.07.088. View

Di Lullo L, Gorini A, Russo D, Santoboni A, Ronco C . Left Ventricular Hypertrophy in Chronic Kidney Disease Patients: From Pathophysiology to Treatment. Cardiorenal Med. 2015; 5(4):254-66. PMC: 4662296. DOI: 10.1159/000435838. View

Kalam K, Otahal P, Marwick T . Prognostic implications of global LV dysfunction: a systematic review and meta-analysis of global longitudinal strain and ejection fraction. Heart. 2014; 100(21):1673-80. DOI: 10.1136/heartjnl-2014-305538. View

Schwartz G, Munoz A, Schneider M, Mak R, Kaskel F, Warady B . New equations to estimate GFR in children with CKD. J Am Soc Nephrol. 2009; 20(3):629-37. PMC: 2653687. DOI: 10.1681/ASN.2008030287. View

Krishnasamy R, Hawley C, Stanton T, Pascoe E, Campbell K, Rossi M . Left ventricular global longitudinal strain is associated with cardiovascular risk factors and arterial stiffness in chronic kidney disease. BMC Nephrol. 2015; 16:106. PMC: 4506621. DOI: 10.1186/s12882-015-0098-1. View

Brady T . The Role of Obesity in the Development of Left Ventricular Hypertrophy Among Children and Adolescents. Curr Hypertens Rep. 2015; 18(1):3. PMC: 4871748. DOI: 10.1007/s11906-015-0608-3. View

Soergel M, Kirschstein M, Busch C, Danne T, Gellermann J, Holl R . Oscillometric twenty-four-hour ambulatory blood pressure values in healthy children and adolescents: a multicenter trial including 1141 subjects. J Pediatr. 1997; 130(2):178-84. DOI: 10.1016/s0022-3476(97)70340-8. View

10.

Ten Harkel A, Cransberg K, van Osch-Gevers M, Nauta J . Diastolic dysfunction in paediatric patients on peritoneal dialysis and after renal transplantation. Nephrol Dial Transplant. 2009; 24(6):1987-91. DOI: 10.1093/ndt/gfp049. View

11.

Rumman R, Ramroop R, Chanchlani R, Ghany M, Hebert D, Harvey E . Longitudinal assessment of myocardial function in childhood chronic kidney disease, during dialysis, and following kidney transplantation. Pediatr Nephrol. 2017; 32(8):1401-1410. DOI: 10.1007/s00467-017-3622-7. View

12.

Hensen L, Goossens K, Delgado V, Rotmans J, Jukema J, Bax J . Prognostic Implications of Left Ventricular Global Longitudinal Strain in Predialysis and Dialysis Patients. Am J Cardiol. 2017; 120(3):500-504. DOI: 10.1016/j.amjcard.2017.04.054. View

13.

Sgambat K, Clauss S, Lei K, Song J, Rahaman S, Lasota M . Effects of obesity and metabolic syndrome on cardiovascular outcomes in pediatric kidney transplant recipients: a longitudinal study. Pediatr Nephrol. 2018; 33(8):1419-1428. DOI: 10.1007/s00467-017-3860-8. View

14.

Shroff R, Degi A, Kerti A, Kis E, Cseprekal O, Tory K . Cardiovascular risk assessment in children with chronic kidney disease. Pediatr Nephrol. 2012; 28(6):875-84. DOI: 10.1007/s00467-012-2325-3. View

15.

Seeman T, Gilik J . Long-term control of ambulatory hypertension in children: improving with time but still not achieving new blood pressure goals. Am J Hypertens. 2013; 26(7):939-45. DOI: 10.1093/ajh/hpt048. View

16.

Akam-Venkata J, Galas J, Aggarwal S . Cardiovascular Evaluation of Children With Malignancies. Curr Treat Options Cardiovasc Med. 2019; 21(3):14. DOI: 10.1007/s11936-019-0719-2. View

17.

Gulhan B, Topaloglu R, Karabulut E, Ozaltin F, Aki F, Bilginer Y . Post-transplant hypertension in pediatric kidney transplant recipients. Pediatr Nephrol. 2014; 29(6):1075-80. DOI: 10.1007/s00467-013-2721-3. View

18.

McGlothan K, Wyatt R, Ault B, Hastings M, Rogers T, DiSessa T . Predominance of nocturnal hypertension in pediatric renal allograft recipients. Pediatr Transplant. 2006; 10(5):558-64. DOI: 10.1111/j.1399-3046.2006.00521.x. View

19.

Borchert-Morlins B, Thurn D, Schmidt B, Buscher A, Oh J, Kier T . Factors associated with cardiovascular target organ damage in children after renal transplantation. Pediatr Nephrol. 2017; 32(11):2143-2154. DOI: 10.1007/s00467-017-3771-8. View

20.

Reusz G, Cseprekal O, Temmar M, Kis E, Bachir Cherif A, Thaleb A . Reference values of pulse wave velocity in healthy children and teenagers. Hypertension. 2010; 56(2):217-24. DOI: 10.1161/HYPERTENSIONAHA.110.152686. View