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Published on: February 10, 2013
Contractility reserve in children undergoing dialysis by dobutamine stress echocardiography
Timur Mese1, Baris Guven, Murat Muhtar Yilmazer
1Department of Pediatric Cardiology, Izmir Dr. Behcet Uz Children's Hospital, Izmir, Turkey.
Insights
Children on chronic dialysis show increased heart muscle mass and contractility at rest. However, their contractile reserve is reduced, indicating a risk for future heart failure, as revealed by dobutamine stress echocardiography.
Area of Science:
- Pediatric Cardiology
- Nephrology
- Cardiovascular Physiology
Background:
- Children on chronic dialysis often develop left ventricular hypertrophy (LVH) as an adaptive response.
- Assessing cardiac function and reserve in these patients is crucial for early detection of potential complications.
Purpose of the Study:
- To evaluate left ventricular performance and contractility reserve in children undergoing chronic dialysis using dobutamine stress echocardiography.
- To identify potential predictors of systolic dysfunction in this population.
Main Methods:
- Prospective study involving 35 children on chronic dialysis and 24 healthy controls.
- Echocardiography assessed end-systolic wall stress and velocity of circumferential fiber shortening (VCFc).
- Dobutamine stress echocardiography was performed on dialysis patients to estimate contractile reserve.
Main Results:
- Dialysis patients exhibited significantly higher VCFc at rest compared to controls.
- Children on dialysis had a markedly increased left ventricular mass index (LVMI).
- Patients with LVH showed significantly lower contractile reserve during dobutamine stress compared to those without LVH.
Conclusions:
- Children on chronic dialysis present with increased resting left ventricular mass and contractility.
- Reduced contractile reserve during dobutamine stress echocardiography suggests an increased risk of developing systolic dysfunction and heart failure.
- Dobutamine stress echocardiography is a valuable tool for risk stratification in pediatric dialysis patients.
Abstract:
Left ventricular hypertrophy is an adaptive mechanism in children undergoing chronic dialysis to improve contractility at rest. The aim of this study was to determine the left ventricular performance and contractility reserve by "dobutamine stress echocardiography" in children undergoing chronic dialysis. Thirty-five children undergoing dialysis and 24 healthy subjects were enrolled in this prospective study. We evaluated contractility by means of end-systolic wall stress-velocity of circumferential fiber shortening (VCFc) in 24 healthy subjects and 35 dialysis patients. Dobutamine stress echocardiography was obtained only in children undergoing dialysis. Patients were divided into two groups according to left ventricular mass index. Contractile reserve was estimated by the difference in contractility at rest versus during echocardiography. Significantly higher VCFc (p = 0.008) and VCFc (p = 0.002) differences at rest were observed in the patient group compared to healthy subjects. Children undergoing dialysis had a higher left ventricular mass index compared with controls (42.38 ± 12.41 vs. 17.57 ± 3.66 g/m(2.7), respectively; p = 0.001). Patients with left ventricular hypertrophy had a significantly lower contractile reserve compared with patients without left ventricular hypertrophy (p = 0.013). These findings suggest that children undergoing dialysis have increased left ventricular mass and contractility at rest. However, the contractile reserve during dobutamine stress echocardiography was reduced. Dobutamine stress echocardiography may identify children undergoing dialysis at risk of progressing to systolic dysfunction and heart failure.
