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Abnormal cardiac function in children after renal transplantation.
Mark M Mitsnefes1, Thomas R Kimball, William L Border
1Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. mark.mitsnefes@chmcc.org
Summary
Pediatric renal transplant recipients often have cardiac hypertrophy. This study found increased left ventricular mass and impaired diastolic function in these children, suggesting left ventricular hypertrophy may risk diastolic dysfunction.
Area of Science:
- Pediatric Cardiology
- Transplant Medicine
- Cardiovascular Physiology
Background:
- Cardiac hypertrophy is common in pediatric renal transplant patients.
- Left ventricular mass (LVM) links to cardiac dysfunction in adult transplant recipients.
- The LVM-cardiac function relationship is unevaluated in pediatric transplant recipients.
Purpose of the Study:
- To evaluate the relationship between LVM and left ventricular (LV) function in children post-renal transplant.
- To assess cardiac structure and diastolic function in pediatric renal allograft recipients.
Main Methods:
- Echocardiography at rest and peak exercise in 29 children with transplants and 33 controls.
- Assessment of LV contractility, contractile reserve, early diastolic relaxation (E-A ratio, Em), and late diastolic compliance (E-Em ratio).
Main Results:
- Children with transplants showed greater LVM index and LV hypertrophy (55%) than controls.
- Increased LV contractility was observed, but contractile reserve was similar.
- Transplant recipients had impaired LV relaxation (lower E-A ratio, Em) and compliance (higher E-Em ratio).
- LVM index predicted abnormal LV relaxation and compliance in transplant recipients.
Conclusions:
- Pediatric renal allograft recipients exhibit impaired cardiac structure and diastolic function.
- Left ventricular hypertrophy (LVH) may be a risk factor for diastolic dysfunction in this population.