Mencarelli Francesca, Fabi Marianna, Corazzi Valentina, Doyon Anke, Masetti Riccardo, Bonetti Simone, Castiglioni Laura, Pession Andrea, Montini Giovanni
Department of Pediatrics, Nephrology Unit, S.Orsola-Malpighi Hospital, University of Bologna, via Massarenti 11, 40138, Bologna, Italy.
Pediatr Nephrol. 2014 May;29(5):893-900. doi: 10.1007/s00467-013-2710-6. Epub 2013 Dec 15.
Cardiovascular disease (CVD) is a common cause of morbidity and mortality in children with chronic kidney disease (CKD). Left ventricular hypertrophy (LVH) and diastolic dysfunction (LVDD) are early markers. The aims of this study were to evaluate (1) LVH and LVDD, using both conventional echocardiographic evaluation and Tissue Doppler Imaging (TDI), and (2) the correlation between cardiac disease and possible risk factors, in children with CKD.
The study cohort comprised 34 paediatric patients with CKD and 34 healthy children (mean ± standard deviation: age 9 ± 4.6 and 8.2 ± 4.3 years, respectively). Thirteen (38 %) patients were in CKD stage 2, 15 (44 %) in stage 3 and six (18 %) in stage 4-5. LVH was defined as a left ventricular mass index (LVMI) of >95th percentile (38 g/h(2.7)).
Left ventricular hypertrophy was present in 13 patients (38 %). Diastolic function evaluated with TDI (E'/A' = early/late diastolic myocardial velocity) worsened with the reduction of glomerular filtration rate (p = 0.020). There was a positive correlation between LVMI and body mass index-standard deviation score (p = 0.020) and a negative correlation between E'/A' and serum phosphorus and calcium levels and their respective product (p = 0.004, p = 0.017, p < 0.001). The relaxation index E' was reduced in 68 % of patients.
Based on our results, TDI is a simple procedure and would appear to be a more accurate diagnostic tool than conventional echocardiography in the early diagnosis of LVDD.
心血管疾病（CVD）是慢性肾脏病（CKD）患儿发病和死亡的常见原因。左心室肥厚（LVH）和舒张功能障碍（LVDD）是早期指标。本研究的目的是评估（1）使用传统超声心动图评估和组织多普勒成像（TDI）来评估LVH和LVDD，以及（2）CKD患儿中心脏疾病与可能的危险因素之间的相关性。
研究队列包括34例CKD儿科患者和34例健康儿童（平均±标准差：年龄分别为9±4.6岁和8.2±4.3岁）。13例（38%）患者处于CKD 2期，15例（44%）处于3期，6例（18%）处于4 - 5期。LVH定义为左心室质量指数（LVMI）>第95百分位数（38 g/h(2.7)）。
13例患者（38%）存在左心室肥厚。用TDI评估的舒张功能（E'/A' = 舒张早期/晚期心肌速度）随着肾小球滤过率的降低而恶化（p = 0.020）。LVMI与体重指数标准差评分之间存在正相关（p = 0.020），E'/A'与血清磷、钙水平及其乘积之间存在负相关（p = 0.004，p = 0.017，p < 0.001）。68%的患者舒张指数E'降低。
基于我们研究结果，TDI是一种简单的检查方法，在LVDD的早期诊断中似乎是比传统超声心动图更准确的诊断工具。
