title: Reduced systolic myocardial function in children with chronic renal insufficiency.
abstract: Increased left ventricular (LV) mass in children with chronic renal insufficiency (CRI) might be adaptive to sustain myocardial performance in the presence of increased loading conditions. It was hypothesized that in children with CRI, LV systolic function is impaired despite increased LV mass (LVM). Standard echocardiograms were obtained in 130 predialysis children who were aged 3 to 18 yr (59% boys) and had stages II through IV chronic kidney disease and in 130 healthy children of similar age, gender distribution, and body build. Systolic function was assessed by measurement of fractional shortening at the endocardial (eS) and midwall (mS) levels and computation of end-systolic stress (myocardial afterload). The patients with CRI exhibited a 6% lower eS (33.1 +/- 5.5 versus 35.3 +/- 6.1%; P < 0.05) and 10% lower mS (17.8 +/- 3.1 versus 19.7 +/- 2.7%; P < 0.001) than control subjects in the presence of significantly elevated BP, increased LVM, and more concentric LV geometry. Whereas the decreased eS was explained entirely by augmented end-systolic stress, mS remained reduced after correction for myocardial afterload. The prevalence of subclinical systolic dysfunction as defined by impaired mS was more than five-fold higher in patients with CRI compared with control subjects (24.6 versus 4.5%; P < 0.001). Systolic dysfunction was most common (48%) in patients with concentric hypertrophy and associated with lower hemoglobin levels. CRI in children is associated with impaired intrinsic LV contractility, which parallels increased LVM.
authors.affiliation: Echocardiography Laboratory, Department of Clinical and Experimental Medicine, "Federico II" University Hospital School of Medicine, Ed.1, Via Sergio Pansini 5, 80131, Napoli, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Chinali
authors.forename: Giovanni
authors.initials: G
authors.lastname: de Simone
authors.forename: Maria Chiara
authors.initials: MC
authors.lastname: Matteucci
authors.forename: Stefano
authors.initials: S
authors.lastname: Picca
authors.forename: Antonio
authors.initials: A
authors.lastname: Mastrostefano
authors.forename: Ali
authors.initials: A
authors.lastname: Anarat
authors.forename: Salim
authors.initials: S
authors.lastname: Caliskan
authors.forename: Nikola
authors.initials: N
authors.lastname: Jeck
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Neuhaus
authors.forename: Amira
authors.initials: A
authors.lastname: Peco-Antic
authors.forename: Licia
authors.initials: L
authors.lastname: Peruzzi
authors.forename: Sara
authors.initials: S
authors.lastname: Testa
authors.forename: Otto
authors.initials: O
authors.lastname: Mehls
authors.forename: Elke
authors.initials: E
authors.lastname: Wühl
authors.forename: Franz
authors.initials: F
authors.lastname: Schaefer
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D005060:Europe; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology*; D008297:Male; D012016:Reference Values; D013599:Systole; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology