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Left ventricular mass and systolic performance in pediatric patients with chronic renal failure

Mark M Mitsnefes1, Thomas R Kimball, Sandra A Witt

  • 1Division of Nephrology and Hypertension, Cincinnati Children's Hospital Research Foundation, Cincinnati, Ohio, USA. mark.mitsnefes@CCHMC.org

Circulation
|February 20, 2003
PubMed

Insights

Children with chronic kidney disease show increased left ventricular mass and contractility at rest. However, dialysis patients exhibit reduced contractile reserve during exercise, potentially signaling future systolic dysfunction.

Area of Science:

  • Pediatric Cardiology
  • Nephrology
  • Cardiovascular Physiology

Background:

  • Children with chronic renal disease often develop left ventricular hypertrophy (LVH).
  • LVH is hypothesized to be an adaptive response to increased afterload and preload in pediatric chronic kidney disease.
  • Understanding LV mass, performance, and contractility is crucial in these vulnerable patients.

Purpose of the Study:

  • To assess the association between left ventricular (LV) mass, LV performance, and LV contractility.
  • To compare these parameters in children with chronic renal insufficiency (CRI) versus those on chronic dialysis.
  • To evaluate contractile reserve during exercise in these pediatric populations.

Main Methods:

  • Echocardiographic evaluation at rest and peak exercise in 25 children with CRI, 12 on chronic dialysis, and 24 controls.
  • Assessment of LV performance using shortening fraction and heart rate-corrected velocity of circumferential fiber shortening (VCF).
  • Determination of contractility and contractile reserve based on VCF, end-systolic wall stress, and exercise response.

Main Results:

  • Both CRI and dialysis groups exhibited significantly higher left ventricular mass (LVM) index compared to controls.
  • At rest, CRI and dialysis groups showed increased VCF and contractility with lower wall stress.
  • Dialysis patients demonstrated significantly lower contractile reserve during peak exercise compared to controls.

Conclusions:

  • Children with CRI and on chronic dialysis present with elevated LVM, LV performance, and contractility at rest.
  • Diminished contractile reserve in dialysis patients during exercise may predict future systolic dysfunction.
  • These findings highlight the cardiac impact of chronic kidney disease and dialysis in children.
Abstract

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