Left ventricular strain and left atrial strain are impaired during hemodialysis in children

Tam T Doan,Nancy A Ayres,Alexandra Idrovo,Poyyapakkam Srivaths,Ayse Akcan-Arikan,Sarah Swartz,Robert W Loar,Carolyn A Altman,Ricardo Pignatelli,Asela Liu,J Kevin Wilkes,Jessica Geer

doi:10.1007/s10554-021-02350-9

Abstract

We aimed to investigate intradialytic changes in ventricular and atrial function using speckle tracking echocardiography (STE) in pediatric hemodialysis (HD). Children with HD vintage > 3months were enrolled, and echocardiography was performed prior to, during, and after HD. STE was analyzed using GE EchoPAC. Left ventricular (LV) global longitudinal strain (GLS), strain rate (Sr), and mechanical dispersion index (MDI) were calculated as the average from 3 apical views; diastolic strain (Ds) and Sr from 4-chamber tracing; left atrial strain (LAS) and Sr from the 4- and 2-chamber views. A total of 15 patients were enrolled at a median age of 12years (IQR 8, 16) and median HD vintage of 13months (IQR 9, 25). GLS worsened during HD (-15.8 ± 2.2% vs -19.9 ± 1.9%, p < 0.001). Post-HD GLS was associated with BP decrease (coefficient = 0.62, p = 0.01). LV MDI and systolic Sr did not change. LV Ds progressively worsened (-8.4% (-9.2, -8.0) vs -11.9% (-13.4, -10.3), p < 0.001). LAS changes at mid-HD returned to baseline post-HD. Ds, DSr, LAS, LASr were not associated with BV removal or BP decrease (p > 0.1). In conclusions, intradialytic LV strain and LAS changes consistent with subclinical systolic and diastolic dysfunction were observed during HD in children. Changes in Ds, DSr, LAS, and LASr were not associated with BP change or BV removal and may be related to the disease progression. Longitudinal study using these novel indices may unfold the effect of these subclinical changes on long-term cardiovascular health in children requiring chronic HD.

Highlights

Cardiovascular complications are common among children with end-stage kidney disease (ESKD) with up to 30% of deaths in children on hemodialysis (HD) due to cardiovascular events [1, 2]
Post-HD global longitudinal strain (GLS) was associated with blood pressures (BP) decrease
left atrial strain (LAS) changes at mid-HD returned to baseline post-HD

Summary

Introduction

Cardiovascular complications are common among children with end-stage kidney disease (ESKD) with up to 30% of deaths in children on hemodialysis (HD) due to cardiovascular events [1, 2]. Left ventricular (LV) global longitudinal strain (GLS), mechanical dispersion index (MDI), and the ratio of early mitral inflow velocity (E) to global diastolic strain rate (Sr) in early diastole (E/DSrE) using 2-dimensional (2-D) speckle tracking echocardiography (STE) are predictors of ventricular arrhythmia and sudden cardiac death in adult dialysis patients [3, 4]. Data on cardiac strain imaging in children with ESRD and HD are limited to markers of systolic function [5,6,7]. Published literature on the assessment of diastolic function in this scenario has been limited to spectral and tissue Doppler imaging, with one study showing diastolic dysfunction at all stages including post transplantation [6]. Markers of diastolic function and left atrial strain (LAS) using 2-D STE can predict outcomes and be potentially better than spectral and tissue Doppler imaging in adults with certain disease states [8]. There is scant data regarding changes in systolic and diastolic function during HD in children

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