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Measuring Cardiac Autonomic Nervous System ANS Activity in Children
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Measuring Cardiac Autonomic Nervous System ANS Activity in Children

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The association between systolic and diastolic dysfunction and autonomic nervous system function in children

Ola H Abd Elaziz1, Ghada M S Ahmad1, Salwa S Abd Elgawad2

  • 1Cardiology Department, Faculty of Medicine (Girls), Al-Azhar University, Cairo, Egypt.

Pediatric Nephrology (Berlin, Germany)
|January 28, 2025
PubMed

Insights

Children with chronic kidney disease (CKD) on hemodialysis (HD) experience reduced cardiac function and autonomic dysfunction. Impaired myocardial deformation and heart rate variability predict higher mortality in these pediatric patients.

Area of Science:

  • Pediatric Cardiology
  • Nephrology
  • Cardiovascular Physiology

Background:

  • Cardiac function and autonomic nervous system associations are poorly understood in children with stage 5 chronic kidney disease (CKD) on hemodialysis (HD).
  • Understanding these changes is crucial for managing pediatric patients with end-stage renal disease.

Purpose of the Study:

  • To investigate cardiac structure, function, and autonomic nervous system activity in children with stage 5 CKD undergoing HD.
  • To identify predictors of mortality in this vulnerable population.

Main Methods:

  • A prospective observational cohort study involving 40 Egyptian children with CKD on HD and 40 healthy controls.
  • Utilized 2D/4D echocardiography, 24-hour Holter monitoring, and clinical/laboratory assessments.
  • Followed participants for mortality and morbidity over 36 months.

Main Results:

  • Children with CKD on HD exhibited significantly reduced left and right ventricular systolic function and impaired heart rate variability post-HD.
  • Global longitudinal strain (GLS) and heart rate variability parameters (rMSSD) correlated with cardiac autonomic function.
  • Reduced LV/RV-GLS and decreased rMSSD were independent predictors of mortality, with a 25% mortality rate observed.

Conclusions:

  • Hemodialysis in children with CKD leads to decreased myocardial deformation (LV/RV-GLS) and cardiac autonomic dysfunction.
  • Increased sympathetic and decreased vagal activity were noted.
  • Reduced LV/RV-GLS and rMSSD are significant independent predictors of mortality in pediatric HD patients.
Abstract

Keywords:
Chronic kidney diseaseGlobal longitudinal shorteningHeart rate variabilitySpeckle tracking echocardiography

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