[Echocardiographic evaluation of left ventricular hemodynamics in children with post-streptococcal acute...

Left ventricular hemodynamics were studied using M-mode and pulsed doppler echocardiography in 18 cases with post-streptococcal acute glomerulonephritis (PSAGN) during the acute phase. Both the ratio of left atrial to aortic dimension and the end-diastolic volume index increased in the acute phase compared with those in the recovery phase in each case (p < 0.01, p < 0.01). These results indicated that the increase in the preload was due to hypervolemia. End-systolic wall stress increased in the acute phase (p < 0.01), thereby the afterload was considered to have increased as well. But the value of systemic vascular resistance showed no significant difference in either phase. Therefore it seems the increase of the afterload was due to increasing blood pressure, which was mainly due to hypervolemia. The ratio of end-systolic wall stress to the end-systolic volume index (ESWS/ESVI) was significantly higher in the acute phase (p < 0.01). Stroke volume index (SI) was also increased in the acute phase (p < 0.01). The increase in SI was considered to be due to a more prominent increase in both the preload and left ventricular contractility than in the afterload. Left ventricular inflow patterns derived from pulsed doppler echocardiography also suggested a markedly increased preload and an increased afterload in the acute phase. These data showed that in the acute phase of PSAGN, left ventricular preload, contractility and afterload were increased due mainly to hypervolemia.