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Isa Tafreshi R, Radgoodarzi M, Arjmandi Rafsanjani K, Soheilipour F. Subclinical Left Ventricular Dysfunction in Children and Adolescence With Thalassemia Intermedia. Front Pediatr 2022; 10:774528. [PMID: 35783313 PMCID: PMC9249082 DOI: 10.3389/fped.2022.774528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 05/24/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Cardiac complications are important causes of morbidity in patients with thalassemia intermedia (TI). We aimed to assess left ventricular (LV) function, using new tissue Doppler imaging (TDI) indices, in order to diagnose early ventricular impairment in asymptomatic children and adolescence with the TI. MATERIALS AND METHODS We investigated possible differences in echocardiographic systolic and diastolic parameters between a population of 28 asymptomatic patients (mean age, 13.6 ± 5.7 years) and 35 age-matched healthy control members. All of them underwent 2-D, pulsed Doppler, and tissue Doppler echocardiographic studies for the assessment of the LV mass, Trans-mitral velocities, mitral annular systolic and diastolic velocities, myocardial performance index (MPI), and myocardial acceleration during isovolumic contraction (IVA). The cardiac iron load was estimated by magnetic resonance imaging T2*. RESULTS Left ventricular hypertrophy (LVH) was found in 13 (46.4%) patients. We found significantly reduced TDI-derived peak systolic myocardial velocity (s') in patients, whereas no significant difference was identified between the patients and control group members when the IVA was compared. The ratio of peak mitral inflow velocity to annular early diastolic velocity (E/e') of the mitral valve as an index of the diastolic function was significantly higher in patients (9 ± 1 vs. 6 ± 1, p < 0.05). Choosing a TDI-derived MPI > 0.33 as a cutoff point, the global LV dysfunction was detected with a sensitivity of 78% and a specificity of 80%. The patients with LVH significantly exhibited higher values of TDI-MPI and lower values of s' velocity and IVA when compared against the subjects with normal LV mass. CONCLUSION Subtle LV systolic and diastolic dysfunction develops early in young patients with the TI who have normal cardiac iron concentration. Moreover, LV remodeling as a main cardiac adaptive response plays a principal role in developing myocardial impairment.
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Affiliation(s)
- Roya Isa Tafreshi
- Department of Pediatric Cardiology, Ali Asghar Children's Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Radgoodarzi
- Department of Pediatrics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Kadijeh Arjmandi Rafsanjani
- Department of Pediatric Hematology and Oncology, Ali Asghar Children's Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Fahimeh Soheilipour
- Department of Pediatric Endocrinology, Minimally Invasive Surgery Research Center, Aliasghar Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Kidney function and the prognostic value of myocardial performance index. Int J Cardiovasc Imaging 2021; 37:1637-1647. [PMID: 33475871 DOI: 10.1007/s10554-020-02149-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 12/24/2020] [Indexed: 10/22/2022]
Abstract
A decreased glomerular filtration rate (GFR) is a risk factor for cardiovascular disease even after adjustment for conventional risk factors. The myocardial performance index (MPI) is defined as (isovolumetric relaxation time (IVRT) + isovolumetric contraction time (IVCT))/ejection time (ET). It has been shown to be an independent predictor of cardiovascular events. We hypothesized the MPI could prove valuable for assessing cardiac risk in subjects of the general population with decreased estimated GFR (eGFR). MPI was measured in 1915 subjects from a large general population prospective cohort study using color tissue Doppler imaging (TDI) M-mode through the mitral valve. We compared the prognostic capabilities of the MPI between subjects with eGFR ≥ 75 mL/min/1.73 m2 and subjects with eGFR < 75 mL/min/1.73 m2 using multivariable adjusted Cox regression models. The composite endpoint was heart failure, myocardial infarction or cardiovascular death. Mean age was 58 years (SD 16.2), 58% were women, 42% had hypertension and 8.3% diabetes. During a median follow-up time of 12.4 years [IQR 10.6-12.7 years] 269 participants reached the combined endpoint. eGFR modified the prognostic capability of MPI (p-value for interaction < 0.001): After multivariable adjustment, MPI remained an independent predictor of the composite endpoint only in participants with eGFR < 75 mL/min/1.73 m2: HR 1.18 (95% CI 1.02-1.38), p = 0.03, vs. in subjects with eGFR ≥ 75 mL/min/1.73 m2: HR 1.14 (95% CI 0.94-1.39), p = 0.17. These results suggest the MPI could be particularly valuable for identifying elevated cardiac risk in individuals from the general population with decreased eGFR.
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Gimpel C, Jung BA, Jung S, Brado J, Schwendinger D, Burkhardt B, Pohl M, Odening KE, Geiger J, Arnold R. Magnetic resonance tissue phase mapping demonstrates altered left ventricular diastolic function in children with chronic kidney disease. Pediatr Radiol 2017; 47:169-177. [PMID: 27966039 DOI: 10.1007/s00247-016-3741-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 09/26/2016] [Accepted: 10/20/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Echocardiographic examinations have revealed functional cardiac abnormalities in children with chronic kidney disease. OBJECTIVE To assess the feasibility of MRI tissue phase mapping in children and to assess regional left ventricular wall movements in children with chronic kidney disease. MATERIALS AND METHODS Twenty pediatric patients with chronic kidney disease (before or after renal transplantation) and 12 healthy controls underwent tissue phase mapping (TPM) to quantify regional left ventricular function through myocardial long (Vz) and short-axis (Vr) velocities at all 3 levels of the left ventricle. RESULTS Patients and controls (age: 8 years-20 years) were matched for age, height, weight, gender and heart rate. Patients had higher systolic blood pressure. No patient had left ventricular hypertrophy on MRI or diastolic dysfunction on echocardiography. Fifteen patients underwent tissue Doppler echocardiography, with normal z-scores for mitral early diastolic (VE), late diastolic (VA) and peak systolic (VS) velocities. Throughout all left ventricular levels, peak diastolic Vz and Vr (cm/s) were reduced in patients: Vzbase -10.6 ± 1.9 vs. -13.4 ± 2.0 (P < 0.0003), Vzmid -7.8 ± 1.6 vs. -11 ± 1.5 (P < 0.0001), Vzapex -3.8 ± 1.6 vs. -5.3 ± 1.6 (P = 0.01), Vrbase -4.2 ± 0.8 vs. -4.9 ± 0.7 (P = 0.01), Vrmid -4.7 ± 0.7 vs. -5.4 ± 0.7 (P = 0.01), Vrapex -4.7 ± 1.4 vs. -5.6 ± 1.1 (P = 0.05). CONCLUSION Tissue phase mapping is feasible in children and adolescents. Children with chronic kidney disease show significantly reduced peak diastolic long- and short-axis left ventricular wall velocities, reflecting impaired early diastolic filling. Thus, tissue phase mapping detects chronic kidney disease-related functional myocardial changes before overt left ventricular hypertrophy or echocardiographic diastolic dysfunction occurs.
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Affiliation(s)
- Charlotte Gimpel
- Department of General Pediatrics, Adolescent Medicine and Neonatology, Center for Pediatrics, Medical Center - University of Freiburg, Mathildenstr. 1, 79106,, Freiburg, Germany.
| | - Bernd A Jung
- Institute of Diagnostic, Interventional and Pediatric Radiology, Inselspital Bern, Bern, Switzerland
| | - Sabine Jung
- Department of Nuclear Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Johannes Brado
- Department of Cardiology and Angiology I, University Heart Center Freiburg, Freiburg, Germany
| | | | - Barbara Burkhardt
- Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Martin Pohl
- Department of General Pediatrics, Adolescent Medicine and Neonatology, Center for Pediatrics, Medical Center - University of Freiburg, Mathildenstr. 1, 79106,, Freiburg, Germany
| | - Katja E Odening
- Department of Cardiology and Angiology I, University Heart Center Freiburg, Freiburg, Germany
| | - Julia Geiger
- Department of Radiology, University Children's Hospital Zurich, Zurich, Switzerland.,Department of Radiology, Northwestern University, 737 N. Michigan Ave., Chicago, IL, USA
| | - Raoul Arnold
- Department of Pediatric and Congenital Cardiology, University Hospital Heidelberg, Heidelberg, Germany
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Jang DM, Jun IG, Moon YJ, Shin WJ, Song JG, Hwang GS. Pretransplant Left Ventricular Dysfunction Adversely Affects Perioperative Outcomes in Pediatric Liver Transplantation: A Retrospective Observational Study. Transplant Proc 2016; 48:3328-3335. [DOI: 10.1016/j.transproceed.2016.08.049] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 07/22/2016] [Accepted: 08/22/2016] [Indexed: 02/07/2023]
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Left ventricular mass and cardiac function in pediatric dialysis patients. PROGRESS IN PEDIATRIC CARDIOLOGY 2016. [DOI: 10.1016/j.ppedcard.2015.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Gerede DM, Turhan S, Kaya CT, Ozcan OU, Goksuluk H, Vurgun VK, Dincer I, Kutlay S, Erturk S, Erol C. Effects of Hemodialysis on Tei Index: Comparison between Flow Doppler and Tissue Doppler Imaging. Echocardiography 2015; 32:1520-6. [DOI: 10.1111/echo.12895] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
| | - Sibel Turhan
- Department of Cardiology; Ankara University School of Medicine; Ankara Turkey
| | - Cansin Tulunay Kaya
- Department of Cardiology; Ankara University School of Medicine; Ankara Turkey
| | - Ozgur Ulas Ozcan
- Department of Cardiology; Ankara University School of Medicine; Ankara Turkey
| | - Huseyin Goksuluk
- Department of Cardiology; Ankara University School of Medicine; Ankara Turkey
| | - Veysel Kutay Vurgun
- Department of Cardiology; Ankara University School of Medicine; Ankara Turkey
| | - Irem Dincer
- Department of Cardiology; Ankara University School of Medicine; Ankara Turkey
| | - Sim Kutlay
- Department of Nephrology; Ankara University School of Medicine; Ankara Turkey
| | - Sehsuvar Erturk
- Department of Nephrology; Ankara University School of Medicine; Ankara Turkey
| | - Cetin Erol
- Department of Cardiology; Ankara University School of Medicine; Ankara Turkey
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Lindblad YT, Axelsson J, Balzano R, Vavilis G, Chromek M, Celsi G, Bárány P. Left ventricular diastolic dysfunction by tissue Doppler echocardiography in pediatric chronic kidney disease. Pediatr Nephrol 2013; 28:2003-13. [PMID: 23740035 DOI: 10.1007/s00467-013-2504-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 04/15/2013] [Accepted: 04/15/2013] [Indexed: 01/20/2023]
Abstract
BACKGROUND Myocardial dysfunction is common in chronic kidney disease (CKD) and related to poor outcomes. New non-invasive methods to assess cardiac function have been introduced, but comparative studies evaluating their clinical usefulness in pediatric CKD are lacking. We studied left ventricular (LV) function in pediatric CKD and renal transplant patients, comparing conventional pulse-wave Doppler echocardiography (cPWD) with newer tissue Doppler imaging (TDI) and relating the results to known cardiovascular risk factors. METHODS The study included 34 children/adolescents with CKD stages 2-5, 44 renal transplant patients and 19 patients with a normal renal function. The mean age was 11.4 (range 0.8-18.8) years. RESULTS Both patient groups had significantly lower LV diastolic function than those with a normal renal function. The most sensitive determinants were TDI E'/A' and cPWD E/TDI E' ratios. In a stepwise linear regression analysis, high blood pressure, young age and the presence of albuminuria all independently predicted LV diastolic function. CONCLUSIONS Our study confirms the high prevalence of LV diastolic dysfunction in pediatric CKD patients and following renal transplantation, where TDI appears to be more sensitive than cPWD in assessing early myocardial dysfunction. Our results also underline the importance of preventive measures, such as rigorous blood pressure control, in pediatric CKD.
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Affiliation(s)
- Ylva Tranæus Lindblad
- Division of Pediatrics, Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
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Simpson JM, Rawlins D, Mathur S, Chubb H, Sinha MD. Systolic and Diastolic Ventricular Function Assessed by Tissue Doppler Imaging in Children with Chronic Kidney Disease. Echocardiography 2012; 30:331-7. [DOI: 10.1111/echo.12015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- John M. Simpson
- Department of Congenital Heart Disease; Evelina Children's Hospital, Guys & St Thomas' NHS Foundation Trust; London; UK
| | - Debbie Rawlins
- Department of Congenital Heart Disease; Evelina Children's Hospital, Guys & St Thomas' NHS Foundation Trust; London; UK
| | - Sujeev Mathur
- Department of Congenital Heart Disease; Evelina Children's Hospital, Guys & St Thomas' NHS Foundation Trust; London; UK
| | - Henry Chubb
- Department of Congenital Heart Disease; Evelina Children's Hospital, Guys & St Thomas' NHS Foundation Trust; London; UK
| | - Manish D. Sinha
- Department of Paediatric Nephrology; Evelina Children's Hospital, Guys & St Thomas' NHS Foundation Trust; London; UK
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Said K, Hassan M, Baligh E, Zayed B, Sorour K. Ventricular Function in Patients with End-Stage Renal Disease Starting Dialysis Therapy: A Tissue Doppler Imaging Study. Echocardiography 2012; 29:1054-9. [DOI: 10.1111/j.1540-8175.2012.01749.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Shabanian R, Aboozari M, Kiani A, Seifirad S, Zamani G, Nahalimoghaddam A, Kocharian A. Myocardial Performance Index and Atrial Ejection Force in Patients with Duchenne's Muscular Dystrophy. Echocardiography 2011; 28:1088-94. [DOI: 10.1111/j.1540-8175.2011.01515.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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Ouali S, Bougmiza I, Abroug S, Omezzine A, Ben Salem H, Neffeti E, Remedi F, Bouslema A, Harabi A, Boughzela E. Relationship of brain natriuretic peptide concentrations to left ventricular function and adverse outcomes in children with end-stage renal disease undergoing hemodialysis. Pediatr Cardiol 2011; 32:568-77. [PMID: 21336977 DOI: 10.1007/s00246-011-9909-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Accepted: 01/31/2011] [Indexed: 11/28/2022]
Abstract
B-type natriuretic peptide (BNP) is a biomarker of cardiovascular disease that is common in adults with chronic kidney disease (CKD). However, in children with CKD, the range and predictive power of BNP concentrations are not known. We aimed to determine the effect of HD on BNP, as well as the prognostic impact of BNP, in end-stage renal disease (ESRD) children undergoing hemodialysis (HD). Thirty-five children with chronic renal failure (16 boys age 12.1 ± 3.7 years) on maintenance HD were included. BNP level was measured, and Doppler echocardiography was performed 30 min before (pre-HD BNP) and 30 min after (post-HD BNP) HD in each patient. An adverse event was defined as all-cause death and heart failure hospitalization. The median pre-HD BNP, the post-HD BNP, and the change in BNP were, respectively, 240 pg/ml (72 to 3346), 318 pg/ml (79 to 3788), and 9 pg/ml (-442 to 1889). Pre-HD BNP concentration was negatively correlated with left ventricular (LV) ejection fraction (r = -0.41, P = 0.018). During a mean follow-up of 39 ± 14 months, 6 patients died, and 3 were hospitalized for heart failure. Using univariate analysis, BNP before and after HD as well as Doppler tissue imaging velocities had a strong graded relationship with adverse events. Cox proportional hazards model demonstrated that pre-HD body weight (P = 0.008), pre-HD BNP (P = 0.011), and post-HD BNP (P = 0.038) remained independent predictors of adverse outcome. Even in case of ESRD, BNP still strongly correlated with LV systolic and diastolic dysfunction and was associated with mortality in HD children.
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Affiliation(s)
- Sana Ouali
- Department of Cardiology, Sahloul Hospital, Cité Sahloul 5054, Sousse, Tunisia.
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