van Huis Maike, Schoenmaker Nikki J, Groothoff Jaap W, van der Lee Johanna H, van Dyk Maria, Gewillig Marc, Koster Linda, Tanke Ronald, Lilien Marc, Blom Nico A, Mertens Luc, Kuipers Irene M
Department of Pediatric Nephrology, Emma Children's Hospital, Academic Medical Center (AMC) Amsterdam/University of Amsterdam, Amsterdam, The Netherlands.
Pediatric Clinical Research Office, Emma Children's Hospital, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
Pediatr Nephrol. 2016 Sep;31(9):1499-508. doi: 10.1007/s00467-016-3362-0. Epub 2016 May 17.
Left ventricular dysfunction is an important co-morbidity of end-stage renal disease (ESRD) and is associated with a poor prognosis in the adult population. In pediatric ESRD, left ventricular function is generally well preserved, but limited information is available on early changes in myocardial function. The aim of this study was to investigate myocardial mechanics in pediatric patients with ESRD using speckle-tracking echocardiography (STE).
Echocardiographic studies, including M-mode, tissue Doppler imaging (TDI) and STE, were performed in 19 children on dialysis, 17 transplant patients and 33 age-matched controls. Strain measurements were performed from the apical four-chamber and the short axis view, respectively.
The interventricular and left ventricular posterior wall thickness was significantly increased in dialysis and transplant patients compared to healthy controls. No significant differences were found in shortening fraction, ejection fraction and systolic tissue Doppler velocities. Dialysis and transplant patients had a decreased mean longitudinal strain compared to healthy controls, with a mean difference of 3.1 [95 % confidence interval (CI) 2.0-4.4] and 2.7 (95 % CI 1.2-4.2), respectively. No differences were found for radial and circumferential strain.
Speckle-tracking echocardiography may reveal early myocardial dysfunction in the absence of systolic dysfunction measured by conventional ultrasound or TDI in children with ESRD.
左心室功能障碍是终末期肾病（ESRD）的一种重要合并症，与成年人群的不良预后相关。在儿童ESRD中，左心室功能通常保存良好，但关于心肌功能早期变化的信息有限。本研究的目的是使用斑点追踪超声心动图（STE）研究儿童ESRD患者的心肌力学。
对19名接受透析的儿童、17名移植患者和33名年龄匹配的对照者进行了超声心动图研究，包括M型、组织多普勒成像（TDI）和STE。分别从心尖四腔心和短轴视图进行应变测量。
与健康对照相比，透析和移植患者的室间隔和左心室后壁厚度显著增加。在缩短分数、射血分数和收缩期组织多普勒速度方面未发现显著差异。与健康对照相比，透析和移植患者的平均纵向应变降低，平均差异分别为3.1[95%置信区间（CI）2.0 - 4.4]和2.7（95%CI 1.2 - 4.2）。径向和周向应变未发现差异。
斑点追踪超声心动图可能揭示ESRD儿童在常规超声或TDI测量的收缩功能正常的情况下早期心肌功能障碍。
