Subclinical systolic dysfunction in pediatric patients with chronic kidney disease.
OBJECTIVE
Midwall shortening (mwSF) is thought to be a more accurate measure of myocardial performance in the presence of left ventricular hypertrophy (LVH). We examined mwSF in pediatric patients with varying degrees of chronic kidney disease (CKD).


METHODS
Fifty-seven children with CKD stages 2 to 4, 25 who were undergoing hemodialysis and 49 who were transplant recipients, were compared with 35 healthy control subjects. Left ventricular (LV) geometry and indices of LV function were assessed echocardiographically.


RESULTS
There were no significant differences in LV contractility or endocardial shortening fraction between patients and control subjects. Yet, patients undergoing hemodialysis had significantly lower mwSF compared with control subjects (P < .01) and patients with stage 2 to 4 CKD (P < .01). Renal transplant patients had lower mwSF compared with control subjects (P < .01). The prevalence of abnormal mwSF (ie, <16) was significantly higher in patients undergoing hemodialysis (40%) compared with patients who were renal transplant recipeints (12%) and patients with CKD stages 2 to 4 (9%; P = .03). With stepwise regression, mwSF was demonstrated to be predicted by using relative wall thickness (P < .0001), dialysis group (P = .005), and endocardial shortening fraction (P = .001; model R(2) = 0.86).


CONCLUSIONS
Children undergoing maintenance hemodialysis and children with concentric LVH have subclinical systolic dysfunction, which might be an indicator for the development of more severe cardiac disease.
Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
Donald J
DJ
Weaver
Thomas
T
Kimball
Sandra A
SA
Witt
Betty J
BJ
Glascock
Phillip R
PR
Khoury
Janis
J
Kartal
Mark M
MM
Mitsnefes
D000293:Adolescent; D002648:Child; D002908:Chronic Disease; D015150:Echocardiography, Doppler; D005260:Female; D005919:Glomerular Filtration Rate; D006321:Heart / Q000503:physiopathology*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D007674:Kidney Diseases / Q000150:complications*; D016030:Kidney Transplantation / Q000502:physiology; D008297:Male; D006435:Renal Dialysis; D013599:Systole / Q000502:physiology