Systolic Dysfunction in children with ESRD Conventional EchoTissue dopplerSpeckle Tracking Echo.

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Presentation transcript:

Systolic Dysfunction in children with ESRD Conventional EchoTissue dopplerSpeckle Tracking Echo

Systolic Dysfunction Children with ESRD: LVH and diastolic dysfunction Systolic dysfunction (SD)? Adults + CKD: SD clinical signs of cardiac failure and decreased survival 1 Systolic function is thought to be preserved in children 2 (measured by conventional US and TDI) New: Speckle Tracking Echocardiography (STE) may unmask more subtle changes in systolic function 1.Parfrey NDT Johnstone. Kidney Int 1996

Systolic Dysfunction Conventional Echo Tissue Doppler Imaging (TDI) Speckle Tracking Echo (STE)

Systolic Dysfunction Conventional Echo SF= Shortening fraction= change in diameter of LV (%) Tissue Doppler Imaging Speckle Tracking Echo (STE)

SF (%)

Systolic Dysfunction Conventional Echo Tissue Doppler Imaging S= Peak systolic velocity of myocard (cm/s) Speckle Tracking Echo (STE)

TDI S

Systolic Dysfunction Conventional Echo Tissue Doppler Imaging Speckle Tracking Echo (STE) Longitudinal strain: myocardial LV deformation (%)

Speckle Tracking Echo Healthy adults Adults with hypertension

Literature Adults: -STE is accurate (compared to MRI and TDI) 2 -STE and hypertension: SD before LVH 3 -STE and ESRD: CKD associated with a reduction of systolic function quantified by STE 4 - Advantage: Load and angle indepenent 5 Children: -STE is accurate & reproducible in healthy children 6 -STE and ESRD: no previous studies 2. Geyer et al. JASE Imbalzano et al. Echocardiography Liu et al. Am. J. Nephrol Burns et al, Euro J. echocardio Singh et al JASE 2010

Methods 1.STE ESRD (n=47) vs controls (n=26) Children from Amsterdam, Nijmegen and Leuven 2. STE vs conventional US and TDI: ESRD (n=27) vs controls (n=21) all from Amsterdam 3. Intra-observer reproducibility ESRD (n=15) and controls (n=10) 4. SD and ESRD related outcomes (n=47)

Results 1 ESRD children were sign. older than controls (p=0.030), matched for BSA Problem: more girls in the control group (p=0.004) (still measuring healthy boys) After adjustement for age and gender by lineair regression: ESRD n=47 mean (sd) Healthy n= 26 mean (sd) Mean difference (95%CI) P value Mean strain (%) 17.5 (3.2)20.6 (2.1)2.7 ( )0.001

2. STE vs US and TDI ESRD n=27 mean (sd) Controls n=21 mean (sd) P value BSA (m 2 ) 1.3 (0.3)1.3 (0.4) Age (years)13.3 (4.4)11.1 (4.3)0.099 Male n (%)17 (63%)6 (29%)0.018 USSF (%)38.4 (5.2)38.1 (4.6)0.692* TDISeptum S’ (cm/s)7.9 (1.5)8.0 (1.2)0.230* LV S’ (cm/s) 8.8 (2.8)9.6 (3.0) 0.211* SpeckleMean strain (%)17.3 (2.7)20.7 (2.2)0.016* * Adjusted for age and gender

3. Reproducibility (n=25) Measurement 1 mean (sd) Measurement 2 mean (sd) Limits of Agreement CV Mean long. strain (%) 18.5 (3.1)18.7 (2.9) % Cv: coefficient of variation measures variability in relation to the mean

4. Association between SD and …. ESRD children with SD* : 31/47 (66%) Children with SD were sign. older, mean (sd) age: 14.3 (3.3) vs 9.5 (4.3) years (p<0.001) No significant associations were found with duration RRT/ Tx/ dialysis or bloodpressure, iPTH, Hb and phosphate The associations with FGF 23 and Klotho has to be evaluated *SD= systolic dysfunction defined as mean long strain < p 5 for age. Marcus et al. JASE 2011

Conclusions Measured by STE children with ESRD have significantly decreased LV systolic function compared to healthy matched controls STE is more sensitive in detection of SD than conventional echocardiography and TDI Longitudinal studies are necessary to evaluate the progression of cardiac dysfunction in these children

Questions

Correlation DD and SD