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Updated: May 16, 2026
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Systolic and diastolic ventricular function assessed by tissue Doppler imaging in children with chronic kidney
John M Simpson1, Debbie Rawlins, Sujeev Mathur
1Department of Congenital Heart Disease, Evelina Children's Hospital, Guys & St Thomas' NHS Foundation Trust, London, UK. john.simpson@gstt.nhs.uk
Insights
Children with chronic kidney disease (CKD) show ventricular dysfunction on tissue Doppler imaging (TDI), worsening with age. These subtle cardiac changes are not detected by standard methods, highlighting TDI
Area of Science:
- Pediatric Nephrology
- Cardiology
- Echocardiography
Background:
- Chronic kidney disease (CKD) in children increases cardiovascular risk.
- Ventricular dysfunction assessment in pediatric CKD is limited.
- Tissue Doppler imaging (TDI) offers sensitive cardiac evaluation.
Purpose of the Study:
- To investigate ventricular systolic and diastolic function in children with CKD using TDI.
- To correlate TDI findings with patient age and traditional echocardiographic parameters.
Main Methods:
- Prospective cross-sectional echocardiographic study.
- Involved 49 pediatric patients with CKD stages 3 or 4.
- Utilized Tissue Doppler imaging (TDI) to assess mitral valve annular velocities (e', a', s') and E/e' ratio.
Main Results:
- TDI revealed abnormalities in systolic (s') and diastolic (e') function.
- Negative correlation found between e' and s' z-scores with patient age.
- Positive correlation between E/e' ratio and patient age.
- No correlation between TDI parameters and blood pressure, LV mass, or RWT.
- Significant correlation between e' and s' suggesting combined systolic/diastolic dysfunction.
Conclusions:
- Children with CKD exhibit subclinical ventricular dysfunction detectable by TDI.
- Ventricular function appears to worsen with increasing age in pediatric CKD.
- TDI provides valuable insights into cardiac health in pediatric CKD beyond standard echocardiography.
Abstract:
Chronic kidney disease (CKD) is associated with elevated cardiovascular risk even during childhood. Tissue Doppler is a sensitive technique for the assessment of ventricular dysfunction with relatively little data available in children with CKD. We report a prospective cross-sectional echocardiographic study at a tertiary center. Forty-nine patients with median (range) age 11.2 years (6.9-17.9), weight 39.6 kg (23.6-99.7) and height 146 cm (122-185). Thirty-one patients were male. Median duration of follow-up for CKD was 7.1 years (range 0.13-16.9). Patients were in CKD stage 3 (n = 37) or 4 (n = 12). Mitral valve E-wave, A-wave, and E/A ratio showed mean (SD) z-scores of 0.08 (0.93), 0.12 (0.82) and -0.13 (0.84), respectively. Tissue Doppler imaging (TDI) at the lateral mitral valve annulus showed e', a', s', and E/e' z-scores mean (SD) -1.10 (0.76), -0.29 (0.92), -1.2 (0.7), and 0.86 (1.1), respectively. There was a significant negative correlation of e' and s' z-score with patient age. E/e' ratio correlated positively with patient age. Blood pressure, left ventricular mass, and relative wall thickness did not correlate with tissue Doppler measurements. The e' and s' velocities correlated significantly with each other, suggesting an interaction of systolic and diastolic dysfunction. Children with CKD may have abnormalities of systolic and diastolic ventricular function on TDI, which are not evident on blood pool Doppler. The tissue Doppler results are consistent with worsening ventricular function in older patients.
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