title: Inhomogeneous Longitudinal Cardiac Rotation and Impaired Left Ventricular Longitudinal Strain in Children and Young Adults with End-Stage Renal Failure Undergoing Hemodialysis.
abstract: BACKGROUND
  Cardiac dysfunction frequently complicates the clinical course of patients with end-stage renal failure (ESRF). Recently, we observed abnormal longitudinal cardiac rotation (LR) among patients with ESRF. In this study, we sought to quantify LR mechanics in patients undergoing hemodialysis (HD).
  
  
  METHODS
  Twenty-four subjects, 12 ESRF patients (58% male; age 17.5 ± 4.4 years) receiving HD, and 12 aged-matched controls, were prospectively studied. Patients underwent echocardiographic studies before and after HD. LR mechanics were quantified with two-dimensional speckle tracking echocardiography. Peak systolic left ventricular (LV) longitudinal strain and displacement measurements were obtained in all subjects.
  
  
  RESULTS
  LR mechanics were successfully quantified in all subjects using 5 key echocardiographic features of LR. We identified two different inhomogeneous LR motion patterns in 41.7% of ESRF patients, characterized by a delayed timing of LR or increased segmental apical rotation. Inhomogeneous LR patterns were not found in controls. Timing of early-systolic counterclockwise LR increased after HD (P = 0.006). In patients, late-systolic clockwise LR occurred earlier (P = 0.043), and showed a significant prolongation after HD (P = 0.003). Longitudinal strain was significantly impaired in patients (P = 0.015), and further decreased after HD (P < 0.0001). Strong correlations were observed between strain and displacement parameters and LR mechanics.
  
  
  CONCLUSIONS
  Quantifying LR using speckle tracking echocardiography was feasible, easy, and reproducible. Inhomogeneous LR motion patterns were demonstrated in a large proportion of patients with ESRF. LV dysfunction seems the most important determinant of inhomogeneous LR. Further studies are required to validate these findings.
authors.affiliation: Department of Pediatric Cardiology, Heart Center Cologne, University Hospital of Cologne, Cologne, Germany.
authors.forename: Ruth
authors.initials: R
authors.lastname: Lagies
authors.affiliation: Institute of Human Genetics, University of Cologne, Cologne, Germany.
authors.forename: Bodo B
authors.initials: BB
authors.lastname: Beck
authors.affiliation: Department of Pediatrics, Division of Pediatric Nephrology, University of Bonn, Bonn, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Hoppe
authors.affiliation: Department of Pediatric Cardiology, Cairo University Children's Hospital (CUCH), Cairo, Egypt.
authors.forename: Sahar S
authors.initials: SS
authors.lastname: Sheta
authors.affiliation: Institute for Medical Statistics, Informatics and Epidemiology (IMSIE), University of Cologne, Cologne, Germany.
authors.forename: Verena
authors.initials: V
authors.lastname: Weiß
authors.affiliation: Department of Pediatric Cardiology, Heart Center Cologne, University Hospital of Cologne, Cologne, Germany.
authors.forename: Narayanswami
authors.initials: N
authors.lastname: Sreeram
authors.affiliation: Department of Pediatric Cardiology, Heart Center Cologne, University Hospital of Cologne, Cologne, Germany.
authors.forename: Floris E A
authors.initials: FE
authors.lastname: Udink ten Cate
mesh_terms: D000293:Adolescent; D004452:Echocardiography / Q000379:methods*; D055119:Elastic Modulus; D054459:Elasticity Imaging Techniques / Q000379:methods; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy*; D008297:Male; D006435:Renal Dialysis / Q000009:adverse effects*; D015203:Reproducibility of Results; D012399:Rotation; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000503:physiopathology
keywords: apical rocking; end-stage renal failure; hemodialysis; longitudinal rotation; speckle tracking echocardiography