ESPN 50th Annual Meeting

ESPN 2017


 
Impaired Systolic and Diastolic Left Ventricular (LV) Function in Children with Chronic Kidney Disease (CKD): Results from the Cardiovascular Comorbidity in Children with CKD (4C) Study
ANKE DOYON 1 PASCAL HAAS 1 BRUNO RANCHIN 2 FRANCESCA MENCARELLI 3 FRANCESCA LUGANI 4 JEROME HARAMBAT 5 MARIACHIARA MATTEUCCI 6 SANDRA HABBIG 7 ARIANE ZALOSZYC 8 SARA TESTA 9 THOMAS GINER 10 ENRICO VIDAL 11 CHARLOTTE GIMPEL 12 PELIN ERTAN 13 NILGUN CAKAR 14 GUL OZCELIK 15 UWE QUERFELD 16 FRANZ SCHAEFER 1

1- CENTER FOR PEDIATRICS AND ADOLESCENT MEDICINE, HEIDELBERG, GERMANY
2- DEPARTMENT OF PEDIATRIC NEPHROLOGY, RHEUMATOLOGY AND DERMATOLOGY, HOSPICES CIVILS DE LYON, FRANCE
3- NEPHROLOGY AND DIALYSIS UNIT, DEPARTMENT OF PEDIATRICS, AZIENDA OSPEDALIERO UNIVERSITARIA SANT ORSOLA-MALPIGHI, BOLOGNA, ITALY
4- DEPARTMENT OF PEDIATRIC NEPHROLOGY, ISTITUTO GIANNINA GASLINI, GENOVA, ITALY
5- PEDIATRIC NEPHROLOGY UNIT, DEPARTMENT OF PEDIATRICS, BORDEAUX UNIVERSITY HOSPITAL, BORDEAUX, FRANCE
6- DEPARTMENT OF NEPHROLOGY AND UROLOGY, BAMBINO GESù PEDIATRIC HOSPITAL, ROME, ITALY
7- UNIVERSITY CHILDRENS HOSPITAL COLOGNE, GERMANY
8- PEDIATRIC NEPHROLOGY UNIT, HAUTEPIERRE UNIVERSITY HOSPITAL, STRASBOURG, FRANCE
9- PEDIATRIC NEPHROLOGY, DIALYSIS AND TRANSPLANT UNIT, FONDAZIONE OSP MAGGIORE POLICLINICO, MILAN, ITALY
10- DEPARTMENT OF PEDIATRICS, MEDICAL UNIVERSITY OF INNSBRUCK, AUSTRIA
11- PEDIATRIC NEPHROLOGY, DIALYSIS AND TRANSPLANT UNIT, DEPARTMENT OF WOMENS AND CHILDRENS HEALTH, UNIVERSITY HOSPITAL OF PADOVA, ITALY
12- CENTER FOR PEDIATRICS AND ADOLESCENT MEDICINE, FREIBURG IM BREISGAU, GERMANY
13- PEDIATRIC NEPHROLOGY DEPARTMENT, CELAL BAYAR UNIVERSITY, MANISA, TURKEY
14- DISKAPI CHILDRENS HOSPITAL, ISTANBUL, TURKEY
15- PEDIATRIC NEPHROLOGY, SISLI EGITIM VE ARASTIRMA HASTANESI, COCUK KLINIGI, SISLI ISTANBUL, TURKEY
16- CHARITé CHILDRENS HOSPITAL, BERLIN, GERMANY
 
Introduction:

Tissue doppler velocities are sensitive markers of LV function. The aim of this work was to analyze tissue doppler velocities in a large cohort of children with CKD and to assess risk factors for LV dysfunction.

Material and methods:

A standardized echocardiographic examination was performed in 128 patients of the 4C Study aged 6 -18 years with eGFR 10-60 ml/min/1.73 m2. Tissue doppler measurements included early (E’) and late (A’) diastolic and systolic (S’) velocity at the mitral and septal annulus of the left ventricle. Measured values were normalized to z scores. Predictors of E’/A’, E/E’, S’ and LVMI were assessed by multiple linear regression analysis.

Results:

Tissue doppler diastolic E’ velocity was reduced and A’ increased at the mitral and septal annulus, resulting in a reduced E’ to A’ ratio (z-score -0.14, p<.0001), indicating diastolic dysfunction. Diastolic function (E’/A’) was positively correlated with midwall fractional shortening (r=0.23, p<0.01). Reduced diastolic function was independently associated with declining renal function (p=0.005), increased systolic blood pressure (p=0.045) and pulse wave velocity (p=0.07). LV filling pressure E/E’ was increased (z-score 0.65, p<.0001) and inversely correlated with the E’/A’ ratio. Patients treated by RAS antagonists had significantly lower E/E’. Systolic tissue doppler velocities were significantly decreased (z-score -0.24, p=0.001) and inversely correlated to LV filling pressure (r=-0.40, p<.0001). The LVMI was not associated to systolic or diastolic tissue doppler velocities.

Conclusions:

eGFR, systolic blood pressure and the type of antihypertensive medications are significant predictors of diastolic function in children with CKD. Tissue doppler velocities are independent of LV mass and provide sensitive information about early LV dysfunction in this population.