Ladányi Zsuzsanna, Bárczi Adrienn, Fábián Alexandra, Ujvári Adrienn, Cseprekál Orsolya, Kis Éva, Reusz György Sándor, Kovács Attila, Merkely Béla, Lakatos Bálint Károly
Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
1st Department of Pediatrics, Semmelweis University, Budapest, Hungary.
Front Cardiovasc Med. 2023 Mar 17;10:1094765. doi: 10.3389/fcvm.2023.1094765. eCollection 2023.
Kidney transplantation (KTX) markedly improves prognosis in pediatric patients with end-stage kidney failure. Still, these patients have an increased risk of developing cardiovascular disease due to multiple risk factors. Three-dimensional (3D) echocardiography allows detailed assessment of the heart and may unveil distinct functional and morphological changes in this patient population that would be undetectable by conventional methods. Accordingly, our aim was to examine left- (LV) and right ventricular (RV) morphology and mechanics in pediatric KTX patients using 3D echocardiography.
Pediatric KTX recipients ( = 74) with median age 20 (14-26) years at study enrollment (43% female), were compared to 74 age and gender-matched controls. Detailed patient history was obtained. After conventional echocardiographic protocol, 3D loops were acquired and measured using commercially available software and the ReVISION Method. We measured LV and RV end-diastolic volumes indexed to body surface area (EDVi), ejection fraction (EF), and 3D LV and RV global longitudinal (GLS) and circumferential strains (GCS).
Both LVEDVi (67 ± 17 vs. 61 ± 9 ml/m; < 0.01) and RVEDVi (68 ± 18 vs. 61 ± 11 ml/m; < 0.01) were significantly higher in KTX patients. LVEF was comparable between the two groups (60 ± 6 vs. 61 ± 4%; = NS), however, LVGLS was significantly lower (-20.5 ± 3.0 vs. -22.0 ± 1.7%; < 0.001), while LVGCS did not differ (-29.7 ± 4.3 vs. -28.6 ± 10.0%; = NS). RVEF (59 ± 6 vs. 61 ± 4%; < 0.05) and RVGLS (-22.8 ± 3.7 vs. -24.1 ± 3.3%; < 0.05) were significantly lower, however, RVGCS was comparable between the two groups (-23.7 ± 4.5 vs. -24.8 ± 4.4%; = NS). In patients requiring dialysis prior to KTX ( = 64, 86%) RVGCS showed correlation with the length of dialysis ( = 0.32, < 0.05).
Pediatric KTX patients demonstrate changes in both LV and RV morphology and mechanics. Moreover, the length of dialysis correlated with the contraction pattern of the right ventricle.
肾移植（KTX）显著改善了终末期肾衰竭儿科患者的预后。然而，由于多种风险因素，这些患者发生心血管疾病的风险增加。三维（3D）超声心动图可对心脏进行详细评估，并可能揭示该患者群体中常规方法无法检测到的独特功能和形态变化。因此，我们的目的是使用3D超声心动图检查儿科KTX患者的左心室（LV）和右心室（RV）形态及力学情况。
将研究入组时中位年龄为20（14 - 26）岁的儿科KTX受者（n = 74，43%为女性）与74名年龄和性别匹配的对照者进行比较。获取了详细的患者病史。按照常规超声心动图检查方案，使用商用软件和ReVISION方法采集并测量3D环。我们测量了以体表面积（EDVi）、射血分数（EF）以及3D左心室和右心室整体纵向应变（GLS）和圆周应变（GCS）为指标的左心室和右心室舒张末期容积。
KTX患者的左心室舒张末期容积指数（LVEDVi）（67±17 vs. 61±9 ml/m²；P < 0.01）和右心室舒张末期容积指数（RVEDVi）（68±18 vs. 61±11 ml/m²；P < 0.01）均显著更高。两组间左心室射血分数（LVEF）相当（60±6 vs. 61±4%；P = NS），然而，左心室整体纵向应变（LVGLS）显著更低（-20.5±3.0 vs. -22.0±1.7%；P < 0.001），而左心室圆周应变（LVGCS）无差异（-29.7±4.3 vs. -28.6±10.0%；P = NS）。右心室射血分数（RVEF）（59±6 vs. 61±4%；P < 0.05）和右心室整体纵向应变（RVGLS）（-22.8±3.7 vs. -24.1±3.3%；P < 0.05）显著更低，然而，两组间右心室圆周应变（RVGCS）相当（-23.7±4.5 vs. -24.8±4.4%；P = NS）。在KTX前需要透析的患者（n = 64，86%）中，右心室圆周应变与透析时长相关（r = 0.32，P < 0.05）。
儿科KTX患者的左心室和右心室形态及力学均有变化。此外（此处原文有误，结合前文推测此处应是Moreover），透析时长与右心室的收缩模式相关。
