Kobayashi Daisuke, Patel Sheetal R, Mattoo Tej K, Valentini Rudolph P, Aggarwal Sanjeev
Division of Cardiology, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, 3901 Beaubien Blvd, Detroit, MI 48201-2119, USA.
Pediatr Cardiol. 2012 Oct;33(7):1124-30. doi: 10.1007/s00246-012-0266-z. Epub 2012 Mar 23.
Left-ventricular dyssynchrony (LVD) adversely affects systolic performance and has not been previously evaluated in children with end-stage renal disease (ESRD). We hypothesized (1) that LVD in children with ESRD would be significantly increased compared with controls and (2) that volume load and left-ventricular hypertrophy (LVH) would be associated with increased LVD. This was a prospective observational study in which real-time three-dimensional echocardiographic data were acquired in 27 stable children with ESRD (13 peritoneal dialysis [PD] and 14 hemodialysis [HD]) and 29 normal controls. Data were acquired before and after an HD session. Dyssynchrony index (SDI) was defined per standard formulae and was normalized to cardiac cycle duration (SDIp). Left-ventricular mass (LVM) was obtained from M-mode echocardiography and was normalized to height(2.7) (LVM index). The mean age (13.8 vs. 11.3 years) and SDI, SDIp, LVM, and LVM index were significantly greater among children with ESRD than among controls (p < 0.05). Demographics and heart rates were comparable between HD and PD subgroups, whereas SDI 16 and 12 segments, SDIp 16 segments, and LVM were significantly greater in the HD group. SDI and SDIp 16 segments improved after an HD session (p < 0.05); LVM and LVM index remained unchanged. LVD was significantly greater in patients with LVH compared with those without LVH. Children with ESRD had significant LVD and increased LVM compared with controls. Increased LVD in those undergoing HD rather than PD, as well as the improvement in synchrony after HD, suggest that volume may modulate LVD. LVD was increased in children with LVH. LVD in children with ESRD may have pathogenic implications.
左心室不同步（LVD）对收缩功能有不利影响，此前尚未在终末期肾病（ESRD）儿童中进行评估。我们假设：（1）与对照组相比，ESRD儿童的LVD会显著增加；（2）容量负荷和左心室肥厚（LVH）与LVD增加有关。这是一项前瞻性观察性研究，对27例病情稳定的ESRD儿童（13例接受腹膜透析[PD]，14例接受血液透析[HD]）和29名正常对照者进行了实时三维超声心动图数据采集。在血液透析治疗前后采集数据。不同步指数（SDI）根据标准公式定义，并根据心动周期持续时间进行标准化（SDIp）。左心室质量（LVM）通过M型超声心动图获得，并根据身高(2.7)进行标准化（LVM指数）。ESRD儿童的平均年龄（13.8岁对11.3岁）以及SDI、SDIp、LVM和LVM指数均显著高于对照组（p<0.05）。血液透析组和腹膜透析亚组之间的人口统计学特征和心率具有可比性，而血液透析组的16节段和12节段SDI、16节段SDIp和LVM显著更高。血液透析治疗后，16节段的SDI和SDIp有所改善（p<0.05）；LVM和LVM指数保持不变。与无LVH的患者相比，有LVH的患者LVD显著更高。与对照组相比，ESRD儿童有显著的LVD且LVM增加。接受血液透析而非腹膜透析的患者LVD增加，以及血液透析后同步性改善，提示容量可能调节LVD。LVH儿童的LVD增加。ESRD儿童的LVD可能具有致病意义。
