title: Early cardiac dysfunction in pediatric patients on maintenance dialysis and post kidney transplant.
abstract: BACKGROUND
  Children with advanced chronic kidney disease (CKD) frequently develop left ventricular (LV) hypertrophy. The extent of hypertrophy that results in cardiac dysfunction is unknown. Systolic function, routinely determined by ejection fraction (EF), is usually preserved in these patients. However, a decrease in EF represents an advanced cardiac dysfunction. We used cardiac magnetic resonance (CMR) and phosphorus-31 MR spectroscopy (31P MRS) to assess markers of cardiac dysfunction in young CKD patients.
  
  
  METHODS
  Ten dialysis and ten post-transplant patients completed the study. The outcomes were peak LV myocardial circumferential strain (Ecc); myocardial T2 relaxation time and full width at half maximum (FWHM) of T2 distribution; and phosphocreatinine/adenosine triphosphate (PCr/ATP) to measure muscle energy metabolism. Healthy controls were used for comparison.
  
  
  RESULTS
  All patients had normal EF; nine (45%) had low Ecc. Ecc was lower in dialysis versus transplant (p<0.0001) patients and inversely correlated with LV mass index, r= -0.47, p=0.04. Patients had higher T2 (p=0.056) and FWHM (p=0.01) than controls. T2 levels were positively correlated with LVM index (r=0.46, p=0.04). PCr/ATP was lower in patients than in controls (p=0.02).
  
  
  CONCLUSIONS
  Young patients with advanced CKD and normal EF have early cardiac changes. Association of these abnormalities with increased left ventricular mass (LVM) index suggests development of maladaptive hypertrophy.
authors.affiliation: Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 7022, Cincinnati, OH 45229, USA.
authors.forename: Rossana
authors.initials: R
authors.lastname: Malatesta-Muncher
authors.forename: Janaka
authors.initials: J
authors.lastname: Wansapura
authors.forename: Michael
authors.initials: M
authors.lastname: Taylor
authors.forename: Diana
authors.initials: D
authors.lastname: Lindquist
authors.forename: Kan
authors.initials: K
authors.lastname: Hor
authors.forename: Mark
authors.initials: M
authors.lastname: Mitsnefes
mesh_terms: D000293:Adolescent; D002648:Child; D003430:Cross-Sectional Studies; D006321:Heart / Q000503:physiopathology; D006331:Heart Diseases / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000150:complications* / Q000503:physiopathology; D016030:Kidney Transplantation / Q000009:adverse effects; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy; D009206:Myocardium / Q000378:metabolism / Q000473:pathology; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000209:etiology / Q000503:physiopathology; D013318:Stroke Volume; D055815:Young Adult