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Risk Assessment for Arrhythmia in Pediatric Renal Transplant Recipients
Belde Kasap Demir1,2, Eren Soyaltin, Caner Alparslan
1From the Izmir Katip Celebi University, Faculty of Medicine, Department of Pediatrics, Division of Nephrology and Rheumatology, Izmir, Turkey.
Insights
Pediatric renal transplant recipients show increased ventricular repolarization abnormalities and cardiac changes. Controlling systolic blood pressure is key to reducing corrected QT dispersion and cardiovascular risks in these patients.
Area of Science:
- Pediatric Cardiology
- Transplant Medicine
- Cardiovascular Research
Background:
- Pediatric renal transplant recipients face heightened risks of ventricular arrhythmia and sudden cardiac death.
- Assessing ventricular repolarization markers is crucial for risk stratification in this population.
Purpose of the Study:
- To compare ventricular repolarization markers between pediatric renal transplant recipients and healthy children.
- To identify factors associated with ventricular repolarization abnormalities post-transplant.
Main Methods:
- A cohort of 30 pediatric renal transplant recipients was compared with 30 age- and sex-matched healthy controls.
- Ventricular repolarization indexes, including QT dispersion and T-wave peak-to-end interval dispersion, were measured.
- Correlations between repolarization indexes and clinical variables like blood pressure and left ventricular mass were analyzed.
Main Results:
- Renal transplant patients exhibited significantly higher blood pressure standard deviation scores, QT dispersion, corrected QT dispersion, and left ventricular mass index.
- Corrected QT dispersion was significantly elevated in hypertensive transplant recipients.
- Systolic blood pressure standard deviation score was the primary predictor of prolonged corrected QT dispersion.
Conclusions:
- Pediatric renal transplant recipients may develop ventricular repolarization anomalies and cardiac geometry irregularities.
- Controlling systolic blood pressure is essential to mitigate the risk of corrected QT dispersion.
- Regular cardiovascular risk monitoring using noninvasive methods is recommended for all pediatric renal transplant recipients.
Objectives:
Renal transplant recipients are at risk for ventricular arrhythmia and sudden death. To assess that risk, we compared the ventricular repolarization markers of pediatric renal transplant recipients with those of healthy children.
Materials And Methods:
We included 30 children and adolescents who were followed for at least 6 months after renal transplant; 30 age- and sex-matched children were included for the control group. Demographic features, medications, and laboratory findings were recorded. Blood pressure measurements, ventricular repolarization indexes including QT dispersion, corrected QT dispersion, T-wave peak-to-end interval dispersion, the T-wave peak-to-end interval∕QT ratio, the T-wave peak-to-end interval∕corrected QT ratio, left ventricular mass index, and relative wall thickness were compared between groups. In addition, the correlations of ventricular repolarization indexes with other variables were evaluated.
Results:
Blood pressure standard deviation scores, the mean heart rate, QT dispersion, corrected QT dispersion, the T-wave peak-to-end interval∕QT ratio, the T-wave peak-to-end interval/corrected QT ratio, left ventricular mass index, and relative wall thickness values were significantly higher in renal transplant patients, whereas T-wave peak-to-end interval dispersion, ejection fraction, and fractional shortening were similar between groups. Although ventricular repolarization indexes were similar in patients with and without left ventricular hypertrophy, only corrected QT dispersion was significantly higher in patients with hypertension (P = .006). The only variable that significantly predicted prolonged corrected QT dispersion was the systolic blood pressure standard deviation score (P = .005, β = .403).
Conclusions:
Ventricular repolarization anomalies, hypertension, left ventricular hypertrophy, and cardiac geometry irregularity may be observed after renal transplant in pediatric recipients despite acceptable allograft functions and normal serum electrolyte levels. Control of systolic blood pressure would decrease the risk of ventricular repolarization abnormalities, namely, the corrected QT dispersion. Follow-up of cardiovascular risks with noninvasive methods is recommended in all pediatric renal transplant recipients.
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