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Speckle-Tracking: Incremental Role in Diastolic Assessment of Pediatric Patients with Chronic Kidney Disease
Flora Maciel Penachio1, Maria de Fátima Rodrigues Diniz2, Rosana Sbruzzi Prado Laurino3
1Universidade de São Paulo - Faculdade de Medicina, São Paulo, SP - Brasil.
Insights
Two-dimensional speckle tracking echocardiography (2DST) derived left atrial (LA) strain is a reliable method for assessing diastolic function in pediatric patients with chronic kidney disease (CKD). This technique identified impaired LA strain in children with CKD, correlating with cardiovascular risk factors.
Area of Science:
- Pediatric Cardiology
- Nephrology
- Diagnostic Imaging
Background:
- Cardiovascular complications are a major cause of mortality in pediatric chronic kidney disease (CKD).
- Traditional echocardiographic methods for assessing diastolic function in pediatric CKD are limited.
- Two-dimensional speckle tracking echocardiography (2DST) offers a robust measure of left atrial (LA) strain for diastolic function assessment.
Purpose of the Study:
- To evaluate the utility of LA strain in assessing diastolic function across various stages of pediatric CKD.
- To determine the correlation between LA strain and cardiovascular risk factors in children with CKD.
Main Methods:
- A comparative study involving 55 pediatric CKD patients and 55 healthy controls.
- Standard and 2DST echocardiograms were performed to assess LA strain and other cardiac parameters.
- Data collected from February 2019 to July 2022.
Main Results:
- Pediatric CKD patients exhibited significantly lower LA reservoir strain and higher LA stiffness compared to controls (p<0.0001).
- Left ventricular hypertrophy and uncontrolled hypertension were associated with reduced LA reservoir strain and increased LA stiffness in CKD patients (p<0.0001, p=0.005).
- Left ventricular ejection fraction remained preserved (≥55%) in all CKD patients.
Conclusions:
- LA strain is a feasible and effective tool for evaluating diastolic function in pediatric CKD.
- Impaired LA strain in pediatric CKD is linked to established cardiovascular risk factors, highlighting its clinical significance.
Background:
Cardiovascular complications are the leading cause of mortality in pediatric patients with chronic kidney disease (CKD). Echocardiographic assessment of diastolic function in CKD has been limited to spectral and tissue Doppler imaging, known to be less reliable techniques in pediatrics. Two-dimensional Speckle tracking echocardiography (2DST) derived left atrial (LA) strain has recently been confirmed as a robust measure of diastolic function.
Objectives:
To investigate LA strain role in diastolic assessment of children at different stages of CKD.
Methods:
From February 2019 to July 2022, 55 CKD patients without cardiovascular symptoms and 55 controls were evaluated by standard and 2DST echocardiograms. The level of significance was set at 5% (p<0.05).
Results:
Patients and controls had similar age [9.78 (0.89 - 17.54) vs. 10.72 (1.03 -18,44) years; p = 0.41] and gender (36M:19F vs. 34M:21F; p=0.84). There were 25 non-dialysis patients and 30 dialysis patients. Left ventricular ejection fraction was ≥ 55% in all of them. Comparing CKD and controls, LA reservoir strain was lower (48.22±10.62% vs. 58.52±10.70%) and LA stiffness index was higher [0.14 (0.08-0.48)%-1 vs. 0.11 (0.06-0.23) %-1]; p<0.0001. LV hypertrophy was associated with lower LA reservoir strain (42.05±8.74% vs. 52.99±9.52%), higher LA stiffness [0.23(0.11 - 0.48)%-1 vs. 0.13 (0.08-0.23) %-1 and filling indexes (2.39±0.63 cm/s x %-1 vs. 1.74±0.47 cm/s x %-1; p<0.0001. Uncontrolled hypertension was associated with lower LA reservoir strain (41.9±10.6% vs. 50.6±9.7; p=0.005).
Conclusions:
LA strain proved to be a feasible tool in the assessment of pediatric CKD patients and was associated with known cardiovascular risk factors.
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