Mitsnefes Mark M, Kimball Thomas R, Border William L, Witt Sandra A, Glascock Betty J, Khoury Philip R, Daniels Stephen R
Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Am J Kidney Dis. 2004 Apr;43(4):721-6. doi: 10.1053/j.ajkd.2003.12.033.
Cardiac hypertrophy frequently is found in children with a renal transplant. In adults with a transplant, left ventricular (LV) mass (LVM) is associated with cardiac dysfunction. However, in children with a transplant, the relationship between LVM and LV function has not been evaluated.
Twenty-nine children who underwent transplantation and 33 controls had echocardiographic evaluations during rest and peak exercise. LV contractility was determined based on the relation between heart rate-corrected velocity of circumferential fiber shortening and end-systolic wall stress. Contractile reserve was assessed by the difference between contractility at rest and peak exercise. Early diastole was assessed using indices of LV relaxation derived from transmitral and tissue Doppler and reported as maximal early (E wave) and late (A wave) wave ratio (E-A ratio) and septal mitral annular velocities (Em). Late diastole was determined using an index of LV compliance (E-Em ratio).
Compared with controls, children with a transplant had a significantly greater LVM index (P < 0.001) and high prevalence of LV hypertrophy (LVH; 55%). Transplant recipients had increased LV contractility (P < 0.001). Contractile reserve was similar to that of controls. Patients with a transplant had a lower E-A ratio and Em (P < 0.01 for both variables) and higher E-Em ratio (P < 0.001) than controls. In children with a transplant, LVM index was a significant independent predictor for both abnormal LV relaxation (Em; P = 0.03) and abnormal LV compliance (E-Em ratio; P = 0.02).
Results show impaired cardiac structure and diastolic function in pediatric renal allograft recipients. This suggests that LVH may be a risk factor for diastolic dysfunction in these children.
肾移植儿童中常发现心脏肥大。在成人肾移植患者中，左心室（LV）质量（LVM）与心脏功能障碍有关。然而，在儿童肾移植患者中，LVM与LV功能之间的关系尚未得到评估。
29例接受移植的儿童和33例对照者在静息和运动峰值时进行了超声心动图评估。LV收缩性根据心率校正的圆周纤维缩短速度与收缩末期壁应力之间的关系来确定。收缩储备通过静息和运动峰值时收缩性的差异来评估。舒张早期使用经二尖瓣和组织多普勒获得的LV舒张指标进行评估，并报告为最大早期（E波）和晚期（A波）波比值（E-A比值）以及室间隔二尖瓣环速度（Em）。舒张晚期使用LV顺应性指标（E-Em比值）来确定。
与对照组相比，肾移植儿童的LVM指数显著更高（P < 0.001），LV肥厚（LVH）的患病率也更高（55%）。移植受者的LV收缩性增加（P < 0.001）。收缩储备与对照组相似。移植患者的E-A比值和Em低于对照组（两个变量的P均 < 0.01），E-Em比值高于对照组（P < 0.001）。在肾移植儿童中，LVM指数是LV舒张异常（Em；P = 0.03）和LV顺应性异常（E-Em比值；P = 0.02）的重要独立预测因素。
结果显示小儿肾移植受者存在心脏结构和舒张功能受损。这表明LVH可能是这些儿童舒张功能障碍的一个危险因素。
