Left ventricular mass and systolic function in children with chronic kidney disease-comparing echocardiography with cardiac magnetic resonance imaging.
BACKGROUND
Increased left ventricular mass (LVM) is an important risk marker of uremic cardiovascular disease. Calculation of LVM by echocardiography (Echo) relies on geometric assumptions and in adults on hemodialysis overestimates LVM compared to cardiac magnetic resonance (CMR). We compare both techniques in children with chronic kidney disease (CKD).


METHODS
Concurrent Echo and CMR was performed in 25 children with CKD (14 after kidney transplantation) aged 8-17 years.


RESULTS
Compared to normal children, CMR-LVM was increased (standard deviation score (SDS) 0.39 ± 0.8 (p = 0.03)), stroke volume and cardiac output decreased (SDS -1.76 ± 1.1, p = 0.002 and -1.11 ± 2.0, p = 0.001). CMR-LVM index but not Echo-LVMI correlated to future glomerular filtration rate (GFR) decline (r = -0.52, p = 0.01). Mean Echo-LVM was higher than CMR-LVM (117 ± 40 vs. 89 ± 29 g, p < 0.0001), with wide limits of agreement (-6.2 to 62.8 g). The Echo-CMR LVM difference increased with higher Echo-LVMI (r = 0.77, p < 0.0001). Agreement of classifying left ventricular hypertrophy was poor with Cohen's kappa of 0.08. Mean Echo and CMR-ejection fraction differed by 1.42% with wide limits of agreement (-12.6 to 15.4%).


CONCLUSIONS
Echo overestimates LVM compared to CMR, especially at higher LVM. Despite this, CMR confirms increased LVM in children with CKD. Only CMR-LVMI but not Echo-LVMI correlated to future GFR decline.
Department of Pediatric Cardiology, Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany.
Raoul
R
Arnold
Hospital for Children, Stadtspital Triemli, Zurich, Switzerland.
Daniel
D
Schwendinger
Division of Nuclear Medicine, University Hospital Freiburg, Freiburg, Germany.
Sabine
S
Jung
Center for Pediatrics and Adolescent Medicine, University Hospital Freiburg, Freiburg, Germany.
Martin
M
Pohl
Institute of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern, Switzerland.
Bernd
B
Jung
Department of Radiology, University Children's Hospital Zurich, Zurich, Switzerland.
Julia
J
Geiger
Center for Pediatrics and Adolescent Medicine, University Hospital Freiburg, Freiburg, Germany. charlotte.gimpel@uniklinik-freiburg.de.
Charlotte
http://orcid.org/0000-0003-1296-9081
C
Gimpel
D000293:Adolescent; D002648:Child; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006352:Heart Ventricles / Q000473:pathology*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis* / Q000503:physiopathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D016277:Ventricular Function, Left
Adolescents; CMR; Chronic renal failure; Echocardiography; Ejection fraction; Left ventricular hypertrophy