Civilibal Mahmut, Caliskan Salim, Oflaz Huseyin, Sever Lale, Candan Cengiz, Canpolat Nur, Kasapcopur Ozgur, Arisoy Nil
Department of Paediatric Nephrology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey.
Nephrology (Carlton). 2009 Oct;14(7):636-42. doi: 10.1111/j.1440-1797.2009.01124.x.
Cardiovascular abnormalities are common in children with chronic kidney disease (CKD). Left ventricular (LV) structure and functions have been extensively studied by conventional pulse-wave Doppler echocardiography (cPWD), however, tissue Doppler imaging (TDI) is a relatively new echocardiography method. The aims of this study were to evaluate LV diastolic function in paediatric dialysis patients using cPWD and TDI methods, and to compare the findings obtained with two modalities.
This study included 38 children and adolescents on dialysis (14 haemodialysis and 24 peritoneal dialysis, duration of dialysis 58.0 +/- 32.8 months) and 16 age- and sex-matched healthy subjects.
The mean left ventricular mass index (LVMI) was significantly higher in the patient group (P < 0.001) and the most common cardiac geometry was concentric LV hypertrophy (55%). There was no significant difference in LV systolic function between patient and control groups. However, dialysis patients had worse LV diastolic function both according to cPWD (lower E/A ratio) and TDI (lower Em/Am ratio) than the healthy subjects (P < 0.001 and P = 0.001, respectively). Also, the index of LV filling pressure (E/Em ratio) obtained by the combination of cPWD and TDI was significantly higher in the patients (P < 0.001). Cumulative dose of calcium-based phosphate binder (CBPB), diastolic blood pressure and LVMI were the independent predictors of E/Em ratio.
Our study shows that LV diastolic dysfunction is common in paediatric dialysis patients and TDI findings correlate well with cPWD findings. Similarly, higher dose intake of CBPB, hypertension and LV hypertrophy have a negative effect on LV filling pressure suggesting diastolic function.
心血管异常在慢性肾脏病（CKD）患儿中很常见。左心室（LV）结构和功能已通过传统脉冲波多普勒超声心动图（cPWD）进行了广泛研究，然而，组织多普勒成像（TDI）是一种相对较新的超声心动图方法。本研究的目的是使用cPWD和TDI方法评估儿科透析患者的左心室舒张功能，并比较两种方法获得的结果。
本研究纳入了38名接受透析的儿童和青少年（14名血液透析和24名腹膜透析，透析时间58.0±32.8个月）以及16名年龄和性别匹配的健康受试者。
患者组的平均左心室质量指数（LVMI）显著更高（P<0.001），最常见的心脏形态是同心性左心室肥厚（55%）。患者组和对照组之间的左心室收缩功能无显著差异。然而，与健康受试者相比，透析患者根据cPWD（较低的E/A比值）和TDI（较低的Em/Am比值）的左心室舒张功能更差（分别为P<0.001和P = 0.001）。此外，通过cPWD和TDI联合获得的左心室充盈压指数（E/Em比值）在患者中显著更高（P<0.001）。钙基磷酸盐结合剂（CBPB）的累积剂量、舒张压和LVMI是E/Em比值的独立预测因素。
我们的研究表明，左心室舒张功能障碍在儿科透析患者中很常见，TDI结果与cPWD结果密切相关。同样，较高剂量的CBPB摄入、高血压和左心室肥厚对左心室充盈压有负面影响，提示舒张功能。
