Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 7022, Cincinnati, OH 45229, USA.
Pediatr Nephrol. 2012 Jul;27(7):1157-64. doi: 10.1007/s00467-012-2124-x. Epub 2012 Feb 23.
Children with advanced chronic kidney disease (CKD) frequently develop left ventricular (LV) hypertrophy. The extent of hypertrophy that results in cardiac dysfunction is unknown. Systolic function, routinely determined by ejection fraction (EF), is usually preserved in these patients. However, a decrease in EF represents an advanced cardiac dysfunction. We used cardiac magnetic resonance (CMR) and phosphorus-31 MR spectroscopy (31P MRS) to assess markers of cardiac dysfunction in young CKD patients.
Ten dialysis and ten post-transplant patients completed the study. The outcomes were peak LV myocardial circumferential strain (Ecc); myocardial T2 relaxation time and full width at half maximum (FWHM) of T2 distribution; and phosphocreatinine/adenosine triphosphate (PCr/ATP) to measure muscle energy metabolism. Healthy controls were used for comparison.
All patients had normal EF; nine (45%) had low Ecc. Ecc was lower in dialysis versus transplant (p<0.0001) patients and inversely correlated with LV mass index, r= -0.47, p=0.04. Patients had higher T2 (p=0.056) and FWHM (p=0.01) than controls. T2 levels were positively correlated with LVM index (r=0.46, p=0.04). PCr/ATP was lower in patients than in controls (p=0.02).
Young patients with advanced CKD and normal EF have early cardiac changes. Association of these abnormalities with increased left ventricular mass (LVM) index suggests development of maladaptive hypertrophy.
患有晚期慢性肾脏病（CKD）的儿童常发生左心室（LV）肥大。导致心功能障碍的肥大程度尚不清楚。这些患者的收缩功能通常通过射血分数（EF）来确定，而收缩功能通常是正常的。然而，EF 的降低代表着一种晚期的心脏功能障碍。我们使用心脏磁共振（CMR）和磷-31 磁共振波谱（31P MRS）来评估年轻 CKD 患者的心脏功能障碍的标志物。
10 名透析患者和 10 名移植后患者完成了这项研究。研究结果为左心室心肌周向应变峰值（Ecc）；心肌 T2 弛豫时间和 T2 分布的半高全宽（FWHM）；以及磷酸肌酸/三磷酸腺苷（PCr/ATP）来测量肌肉能量代谢。健康对照组用于比较。
所有患者的 EF 均正常；9 名（45%）患者的 Ecc 较低。与移植（p<0.0001）患者相比，透析患者的 Ecc 更低，且与 LV 质量指数呈负相关，r= -0.47，p=0.04。患者的 T2（p=0.056）和 FWHM（p=0.01）均高于对照组。T2 水平与 LVM 指数呈正相关（r=0.46，p=0.04）。与对照组相比，患者的 PCr/ATP 水平较低（p=0.02）。
患有晚期 CKD 且 EF 正常的年轻患者存在早期心脏变化。这些异常与左心室质量（LVM）指数增加相关，表明适应性肥大的发展。
