ESPN 50th Annual Meeting

ESPN 2017


 
Elevated Myocardial wall stress predicts left ventricular remodelling in children with chronic kidney disease
HAOTIAN GU 2 MANISH SINHA 1 JOHN SIMPSON 1 PHIL CHOWIENCZYK 2

1- EVELINA LONDON CHILDRENS HOPSITAL
2- KINGS COLLEGE LONDON
 
Introduction:

 In children with chronic kidney disease (CKD) myocardial wall stress (MWS) is elevated independent of raised blood pressure and before development of left ventricular hypertrophy. We hypothesised that elevated MWS may predict development of ventricular remodelling over time in children with CKD.

Material and methods:

 In seventy-nine children (10.7 ± 3.0 years) including 56 children with CKD, transthoracic echocardiography and carotid tonometry were performed at baseline and after an average of 24.4±11.0 months follow-up. Endocardial and epicardial volumes were obtained from Tomtec wall tracking analysis.  Left ventricular mass (LVM) was calculated from M-mode. Central aortic pressure during systole was used to estimate LV pressure and was calibrated by mean and diastolic blood pressure (BP). Myocardial wall stress was calculated from LV volume and pressure measurements. 

Results:

 There was a significant increase in height (0.11±0.10m, p<0.001), weight (9.9±9.5kg, p<0.001), systolic (8±11mmHg, p<0.001) and diastolic BP (10±11mmHg, p<0.001). eGFR reduced significantly (-15.7±1.8ml/min per1.73cm2, p<0.001) in CKD group. Among all subjects, change in LVM/EDV was associated with baseline MWS  (β=0.263, p=0.003) after adjustment for age, gender and blood pressures. LVM/EDV changed by -0.185±0.041, -0.033±0.038 and 0.014±0.043 units respectively across tertiles of baseline mean MWS.

Conclusions:

 Elevated MWS is an independent predictor of concentric left ventricular remodeling in children with CKD.