INAPPROPRIATE LEFT VENTRICULAR MASS, IN CHILDREN WITH PREDYALITIC CHRONIC RENAL INSUFFICIENCY

Abstract

Background: Increased left ventricular (LV) mass in children with chronic renal insufficiency (CRI) might represent an adaptive mechanism to compensate for increased workload. We hypothesize that in pre-dialysis CRI children, values of LV mass exceed compensatory value for individual cardiac load. Methods: Complete anthropometrics, biochemical profile and echocardiograms were obtained in 33 children with pre-dialysis CRI (age 1-23 yrs, mean 12.2±5.0 yrs; 22 males) and 33 age- and gender-matched healthy controls. LV dimensions and wall thicknesses were measured from the M-mode, LV volume and long-axis dimension from the 2-D, blood pressure from 24-hour ambulatory recordings. Endocardial shortening, ejection fraction, LV mass, LV mass index, relative wall thickness, circumferential wall stress, and excess of LV mass (as ratio of observed LV mass to value predicted from body size, gender, and cardiac workload) were analyzed. Results: CRI patients showed higher values of indexed LV chamber diameter and LV mass index, resulting in significantly higher prevalence of LVH (36.3 vs 9%; all p<0.05). In addition CRI patients showed lower LV ejection fraction, lower midwall fractional shortening and lower stress-corected midwall shortening. The ratio of excess of LV mass was significantly greater in CRI patients than in normal controls (126±19 vs 103±13%; p<0.001). Conclusions: In CRI children values of LV mass are higher than those needed to sustain individual cardiac load compared to normal controls, a condition associated with LVH and reduced systolic performance.