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Impaired Systolic and Diastolic Left Ventricular Function in Children with Chronic Kidney Disease - Results from the 4C Study.
Sci Rep. 2019 08 07; 9(1):11462.SR

Abstract

Children with chronic kidney disease suffer from excessive cardiovascular mortality and early alterations of the cardiovascular system. Tissue doppler imaging is a validated echocardiographic tool to assess early systolic and diastolic cardiac dysfunction. We hypothesized that tissue Doppler velocities would reveal reduced cardiac function in children with chronic kidney disease compared to healthy children. A standardized echocardiographic exam was performed in 128 patients of the Cardiovascular Comorbidity in Children with Chronic Kidney Disease (4C) Study aged 6-17 years with an estimated glomerular filtration rate (eGFR) below 60 ml/min/1.73 m2. Tissue Doppler measurements included early (E') and late (A') diastolic and systolic (S') velocity at the mitral and septal annulus of the left ventricle. Measured values were normalized to z-scores using published reference data. Predictors of E'/A', E/E', S' and left ventricular mass index (LVMI) were assessed by multiple linear regression analyses. Tissue Doppler E' was reduced and tissue Doppler A' increased, resulting in a reduced tissue Doppler E'/A' ratio (z-score -0.14, p < 0.0001) indicating reduced diastolic function compared to healthy children. Reduced tissue Doppler E'/A' Z-Scores were independently associated with lower eGFR (p = 0.002) and increased systolic blood pressure (p = 0.02). While E/E' Z-Scores were increased (Z-score 0.57, p < 0.0001), patients treated with pharmacological RAS blockade but not with other antihypertensive treatments had significantly lower E/E' and higher E'/A' Z-Scores. Systolic tissue Doppler velocities were significantly decreased (Z-score -0.24, p = 0.001) and inversely correlated with E/E' Z-Scores (r = -0.41, p < 0.0001). LVMI was not associated with systolic or diastolic tissue Doppler velocities. Concentric left ventricular hypertrophy showed a tendency to lower S' in multivariate analysis (p = 0.13) but no association to diastolic function. Concentric left ventricular geometry was significantly associated with lower midwall fractional shortening. In summary, systolic and diastolic function assessed by tissue Doppler is impaired. eGFR, systolic blood pressure and the type of antihypertensive medications are significant predictors of diastolic function in children with CKD. Left ventricular morphology is largely independent of tissue Doppler velocities. Tissue Doppler velocities provide sensitive information about early left ventricular dysfunction in this population.

Authors+Show Affiliations

Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany. anke.doyon@med.uni-heidelberg.de. 4C Study Consortium, Heidelberg, Germany. anke.doyon@med.uni-heidelberg.de.Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany.Division of Pediatric Cardiology, Cukurova University, Adana, Turkey. 4C Study Consortium, Heidelberg, Germany.Department of Pediatric Nephrology, Rheumatology and Dermatology, Hospices Civils de Lyon, Lyon, France. 4C Study Consortium, Heidelberg, Germany.Service de Pharmacotoxicologie, Centre d'Investigation Clinique, 1407 Inserm, UMR 5558, LBBE, CNRS Lyon, Université de Lyon and Hospices Civils de Lyon, Lyon, France.Nephrology and Dialysis Unit, Department of Pediatrics, Azienda Ospedaliero Universitaria Sant Orsola-Malpighi, Bologna, Italy. 4C Study Consortium, Heidelberg, Germany.Department of Pediatric Nephrology, Istituto Giannina Gaslini, Genova, Italy. 4C Study Consortium, Heidelberg, Germany.Pediatric Nephrology Unit, Department of Pediatrics, Bordeaux University Hospital, Bordeaux, France. 4C Study Consortium, Heidelberg, Germany.Department of Nephrology and Urology, Bambino Gesù Pediatric Hospital, Rome, Italy. 4C Study Consortium, Heidelberg, Germany.Department of Cardiology, Bambino Gesù Pediatric Hospital, Rome, Italy. 4C Study Consortium, Heidelberg, Germany.University Childrens' and Adolescents' Hospital Cologne, Cologne, Germany. 4C Study Consortium, Heidelberg, Germany.Pediatric Nephrology Unit, Hautepierre University Hospital, Strasbourg, France. 4C Study Consortium, Heidelberg, Germany.Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione Osp Maggiore Policlinico, Milan, Italy. 4C Study Consortium, Heidelberg, Germany.Pediatric Nephrology, Dialysis and Transplant Unit, Department of Womens and Childrens Health, University Hospital of Padova, Padua, Italy. 4C Study Consortium, Heidelberg, Germany.Department of General Pediatrics, Adolescent Medicine and Neonatology, Center for Pediatrics, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg im Breisgau, Germany. 4C Study Consortium, Heidelberg, Germany.Center for Pediatrics, Vilnius University, Vilnius, Lithuania. 4C Study Consortium, Heidelberg, Germany.Department of Pediatric and Congenital Cardiology, Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany.Division of Pediatric Nephrology, Charite Children's Hospital, Berlin, Germany. 4C Study Consortium, Heidelberg, Germany.Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany. 4C Study Consortium, Heidelberg, Germany.

Pub Type(s)

Journal Article
Observational Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31391470

Citation

Doyon, Anke, et al. "Impaired Systolic and Diastolic Left Ventricular Function in Children With Chronic Kidney Disease - Results From the 4C Study." Scientific Reports, vol. 9, no. 1, 2019, p. 11462.
Doyon A, Haas P, Erdem S, et al. Impaired Systolic and Diastolic Left Ventricular Function in Children with Chronic Kidney Disease - Results from the 4C Study. Sci Rep. 2019;9(1):11462.
Doyon, A., Haas, P., Erdem, S., Ranchin, B., Kassai, B., Mencarelli, F., Lugani, F., Harambat, J., Matteucci, M. C., Chinali, M., Habbig, S., Zaloszyc, A., Testa, S., Vidal, E., Gimpel, C., Azukaitis, K., Kovacevic, A., Querfeld, U., & Schaefer, F. (2019). Impaired Systolic and Diastolic Left Ventricular Function in Children with Chronic Kidney Disease - Results from the 4C Study. Scientific Reports, 9(1), 11462. https://doi.org/10.1038/s41598-019-46653-3
Doyon A, et al. Impaired Systolic and Diastolic Left Ventricular Function in Children With Chronic Kidney Disease - Results From the 4C Study. Sci Rep. 2019 08 7;9(1):11462. PubMed PMID: 31391470.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impaired Systolic and Diastolic Left Ventricular Function in Children with Chronic Kidney Disease - Results from the 4C Study. AU - Doyon,Anke, AU - Haas,Pascal, AU - Erdem,Sevcan, AU - Ranchin,Bruno, AU - Kassai,Behrouz, AU - Mencarelli,Francesca, AU - Lugani,Francesca, AU - Harambat,Jerome, AU - Matteucci,Maria Chiara, AU - Chinali,Marcello, AU - Habbig,Sandra, AU - Zaloszyc,Ariane, AU - Testa,Sara, AU - Vidal,Enrico, AU - Gimpel,Charlotte, AU - Azukaitis,Karolis, AU - Kovacevic,Alexander, AU - Querfeld,Uwe, AU - Schaefer,Franz, Y1 - 2019/08/07/ PY - 2019/02/27/received PY - 2019/06/27/accepted PY - 2019/8/9/entrez PY - 2019/8/9/pubmed PY - 2020/10/28/medline SP - 11462 EP - 11462 JF - Scientific reports JO - Sci Rep VL - 9 IS - 1 N2 - Children with chronic kidney disease suffer from excessive cardiovascular mortality and early alterations of the cardiovascular system. Tissue doppler imaging is a validated echocardiographic tool to assess early systolic and diastolic cardiac dysfunction. We hypothesized that tissue Doppler velocities would reveal reduced cardiac function in children with chronic kidney disease compared to healthy children. A standardized echocardiographic exam was performed in 128 patients of the Cardiovascular Comorbidity in Children with Chronic Kidney Disease (4C) Study aged 6-17 years with an estimated glomerular filtration rate (eGFR) below 60 ml/min/1.73 m2. Tissue Doppler measurements included early (E') and late (A') diastolic and systolic (S') velocity at the mitral and septal annulus of the left ventricle. Measured values were normalized to z-scores using published reference data. Predictors of E'/A', E/E', S' and left ventricular mass index (LVMI) were assessed by multiple linear regression analyses. Tissue Doppler E' was reduced and tissue Doppler A' increased, resulting in a reduced tissue Doppler E'/A' ratio (z-score -0.14, p < 0.0001) indicating reduced diastolic function compared to healthy children. Reduced tissue Doppler E'/A' Z-Scores were independently associated with lower eGFR (p = 0.002) and increased systolic blood pressure (p = 0.02). While E/E' Z-Scores were increased (Z-score 0.57, p < 0.0001), patients treated with pharmacological RAS blockade but not with other antihypertensive treatments had significantly lower E/E' and higher E'/A' Z-Scores. Systolic tissue Doppler velocities were significantly decreased (Z-score -0.24, p = 0.001) and inversely correlated with E/E' Z-Scores (r = -0.41, p < 0.0001). LVMI was not associated with systolic or diastolic tissue Doppler velocities. Concentric left ventricular hypertrophy showed a tendency to lower S' in multivariate analysis (p = 0.13) but no association to diastolic function. Concentric left ventricular geometry was significantly associated with lower midwall fractional shortening. In summary, systolic and diastolic function assessed by tissue Doppler is impaired. eGFR, systolic blood pressure and the type of antihypertensive medications are significant predictors of diastolic function in children with CKD. Left ventricular morphology is largely independent of tissue Doppler velocities. Tissue Doppler velocities provide sensitive information about early left ventricular dysfunction in this population. SN - 2045-2322 UR - https://www.unboundmedicine.com/medline/citation/31391470/Impaired_Systolic_and_Diastolic_Left_Ventricular_Function_in_Children_with_Chronic_Kidney_Disease___Results_from_the_4C_Study_ L2 - https://doi.org/10.1038/s41598-019-46653-3 DB - PRIME DP - Unbound Medicine ER -