Sublclinical Systolic Dysfunction in Pediatric Patients with Chronic Kidney Disease

Objectives Midwall shortening (mwSF) is thought to be a more accurate measure of myocardial performance in the presence of left ventricular hypertrophy (LVH). We examined mwSF in pediatric patients with varying degrees of chronic kidney disease (CKD). Study design Fifty-seven children with CKD stages 2 to 4, 25 who were undergoin hemodialysis and 49 who were transplant recipients, were compared with 35 healthy control subjects. Left ventricular (LV) geometry and indices of IN function were assessed echocardiographically. Results There were no significant differences in LV contractility or endocardial shortening fraction between patients and control subjects. Yet, patients undergoing hemodialysis had significantly lower mwSF compared with control subjects (P < .01) enal transplant patients had lower mwSF compared with control subjects and patients with stage 2 to 4 CKD (P <.01). R (P <.01). The prevalence of abnormal mwSF (ie, < 16) was significantly higher in patients undergoing hemodialysis (40%) compared with patients who were renal transplant recipeints (12%) and patients with Oil) stages 2 to 4 (9%, P =.03). With stepwise regression, mwSF was demonstrated to be predicted by using relative wall thickness (P <.0001), dialysis group (P =.005), and endocardial shortening fraction (P =.001; model R-2 = 0.86). Conclusions Children undergoing maintenance hemodialysis and children with concentric LVH have subclinical systolic dysfunction, which might be in indicator for the development of more severe cardiac disease. (J Pediatr 2008,153:565-9)