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Updated: Jun 29, 2026
Ultrasonic Assessment of Myocardial Microstructure
Published on: January 14, 2014
Diastolic echocardiographic parameters identify pediatric kidney transplant recipients with structural myocardial
Jeannine von der Born1,2, Tim Alexander Ubenauf1,3, Rizky I Sugianto1
1Department of Pediatric Kidney- and Liver Diseases, Metabolics and Neuropediatrics, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
Insights
Echocardiography can detect cardiac changes in pediatric kidney transplant patients. An elevated septal E/e' value on echocardiography may indicate increased risk for myocardial involvement, guiding further cardiovascular magnetic resonance imaging.
Area of Science:
- Cardiology
- Pediatric Nephrology
- Transplantation Medicine
Background:
- Cardiac complications are a leading cause of death in pediatric kidney transplant (KTx) recipients.
- Standardized diagnostic methods to identify at-risk pediatric KTx patients are lacking.
- Cardiovascular magnetic resonance (CMR) with native T1 mapping detects myocardial changes but isn't routine; echocardiography's ability to reflect these changes is unclear.
Purpose of the Study:
- To investigate the association between echocardiographic parameters and myocardial T1 values in pediatric KTx recipients.
- To determine if echocardiography can identify structural myocardial alterations detected by CMR imaging.
Main Methods:
- Pediatric KTx recipients underwent echocardiography and CMR with native T1 mapping.
- Multivariable linear regression analyzed associations between echocardiographic measures and T1 values.
- Receiver operating characteristics analyses identified optimal septal E/e' cut-offs for detecting elevated T1 values.
Main Results:
- Eighty-seven percent of 46 pediatric KTx recipients showed diastolic echocardiographic abnormalities.
- Septal T1 correlated with septal E/e', A-wave, and pulmonary venous atrial reversal.
- Optimal septal E/e' cut-offs of 10.550 and 10.630 identified elevated septal and lateral T1 values, respectively.
Conclusions:
- Routine echocardiography detects myocardial structural alterations in pediatric KTx recipients.
- Elevated septal E/e' is a potential indicator of increased risk for myocardial involvement.
- CMR imaging may be valuable for post-transplant follow-up in at-risk pediatric KTx patients.
Background:
Cardiac complications are among the most common causes of death in patients after pediatric kidney transplantation (KTx), but defined diagnostic procedures identifying young patients at risk are not established. Cardiovascular magnetic resonance (CMR) imaging with native T1 mapping allows detection of diffuse myocardial alterations but is not routinely available for cardiovascular screening. Whether abnormalities detected by echocardiography reflect underlying myocardial structural changes remains unclear.
Methods:
Pediatric KTx recipients underwent comprehensive transthoracic echocardiography and CMR imaging with native T1 mapping. Associations between echocardiographic measures and T1 values were analyzed using multivariable linear regressions. Receiver operating characteristics analyses assessed the ability of septal E/e' to identify elevated T1 values, with area under the curve (AUC) and optimal cut-offs determined using positive likelihood ratios (LR +).
Results:
Forty-six pediatric KTx recipients (16 ± 3.5 years old; time since KTx 7.9 ± 5.3 years) were included. Diastolic echocardiographic abnormalities were common, with 87% exhibiting at least one abnormal diastolic parameter. Septal T1 was associated with septal E/e', A-wave, and pulmonary venous atrial reversal, while lateral T1 was associated only with septal E/e'. Optimal septal E/e' cut-offs were 10.550 for detecting an elevated septal T1 (LR + = 7.143) and 10.630 for detecting an elevated lateral T1 (LR + = 9).
Conclusions:
Pediatric KTx recipients with structural myocardial alterations on CMR imaging exhibit detectable abnormalities in routine echocardiographic diastolic parameters. Especially a markedly elevated septal E/e' could identify patients at increased risk for underlying myocardial involvement and justify the use of CMR imaging in post-transplant follow-up.
