title: Left ventricular diastolic dysfunction by tissue Doppler echocardiography in pediatric chronic kidney disease.
abstract: BACKGROUND
  Myocardial dysfunction is common in chronic kidney disease (CKD) and related to poor outcomes. New non-invasive methods to assess cardiac function have been introduced, but comparative studies evaluating their clinical usefulness in pediatric CKD are lacking. We studied left ventricular (LV) function in pediatric CKD and renal transplant patients, comparing conventional pulse-wave Doppler echocardiography (cPWD) with newer tissue Doppler imaging (TDI) and relating the results to known cardiovascular risk factors.
  
  
  METHODS
  The study included 34 children/adolescents with CKD stages 2-5, 44 renal transplant patients and 19 patients with a normal renal function. The mean age was 11.4 (range 0.8-18.8) years.
  
  
  RESULTS
  Both patient groups had significantly lower LV diastolic function than those with a normal renal function. The most sensitive determinants were TDI E'/A' and cPWD E/TDI E' ratios. In a stepwise linear regression analysis, high blood pressure, young age and the presence of albuminuria all independently predicted LV diastolic function.
  
  
  CONCLUSIONS
  Our study confirms the high prevalence of LV diastolic dysfunction in pediatric CKD patients and following renal transplantation, where TDI appears to be more sensitive than cPWD in assessing early myocardial dysfunction. Our results also underline the importance of preventive measures, such as rigorous blood pressure control, in pediatric CKD.
authors.affiliation: Division of Pediatrics, Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden. ylva.tranaeus-lindblad@karolinska.se
authors.forename: Ylva Tranæus
authors.initials: YT
authors.lastname: Lindblad
authors.forename: Jonas
authors.initials: J
authors.lastname: Axelsson
authors.forename: Rita
authors.initials: R
authors.lastname: Balzano
authors.forename: Georgios
authors.initials: G
authors.lastname: Vavilis
authors.forename: Milan
authors.initials: M
authors.lastname: Chromek
authors.forename: Gianni
authors.initials: G
authors.lastname: Celsi
authors.forename: Peter
authors.initials: P
authors.lastname: Bárány
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003971:Diastole; D015150:Echocardiography, Doppler; D018619:Echocardiography, Doppler, Pulsed; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000503:physiopathology; D007223:Infant; D016030:Kidney Transplantation; D016014:Linear Models; D008297:Male; D011237:Predictive Value of Tests; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000453:epidemiology* / Q000601:surgery; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers