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- Title
Subclinical cardiac dysfunction in pediatric kidney transplant recipients identified by speckle-tracking echocardiography.
- Authors
Bárczi, Adrienn; Lakatos, Bálint Károly; Szilágyi, Mónika; Kis, Éva; Cseprekál, Orsolya; Fábián, Alexandra; Kovács, Attila; Szabó, Attila J.; Merkely, Béla; Salvi, Paolo; Reusz, György S.
- Abstract
Background: Kidney transplantation (KTx) improves prognosis in children with kidney failure; still, these patients are prone to cardiovascular damage due to multiple risk factors. Our aim was to assess myocardial structure and function in pediatric KTx by conventional and speckle-tracking echocardiography (STE) in association with established cardiovascular risk factors. Methods: Forty-two KTx and 39 healthy age- and gender-matched children were evaluated. KTx recipients were further categorized according to the control of hypertension assessed by 24-h ambulatory blood pressure monitoring (ABPM). Subjects underwent pulse wave velocity (PWV) measurement, conventional echocardiography, and 2-dimensional STE. Left and right ventricular (LV, RV) global longitudinal strain (GLS), and LV circumferential strain (GCS) were measured. Glomerular filtration rate (eGFR) was calculated according to the Schwartz formula. Results: KTx patients had increased blood pressure and arterial stiffness. LV ejection fraction (EF) was preserved along with elevated LV mass index (LVMi) while LVGLS was significantly lower, whereas LVGCS and RVGLS were increased in KTx. Uncontrolled hypertensives had lower LVGLS compared to those with controlled hypertension. Using multiple forward stepwise regression analysis, 24-h SBP and relative wall thickness (RWT) were independent determinants of LVMi, whereas antihypertensive therapy, eGFR, and HOMA-IR were independent determinants of LVGLS. Conclusions: Cardiac morphology and function show distinct changes after KTx. Along with comparable ventricular volumes, LV hypertrophy and subclinical myocardial dysfunction are present. Control of hypertension and kidney graft function are major factors of LV performance. STE may be useful to reveal early myocardial dysfunction in pediatric KTx. A higher resolution version of the Graphical abstract is available as Supplementary information.
- Subjects
ECHOCARDIOGRAPHY; CHRONIC kidney failure; GLOMERULAR filtration rate; BLOOD pressure; KIDNEY transplantation; PATIENTS; CARDIOVASCULAR diseases; REGRESSION analysis; ARTERIAL diseases; TRANSPLANTATION of organs, tissues, etc.; CHILDREN
- Publication
Pediatric Nephrology, 2022, Vol 37, Issue 10, p2489
- ISSN
0931-041X
- Publication type
Article
- DOI
10.1007/s00467-022-05422-7