Left ventricular mass and cardiac function in a population of children with chronic kidney disease

Background: Cardiovascular disease (CVD) is a common cause of morbidity and mortality in children with chronic kidney disease (CKD). Left ventricular hypertrophy (LVH) and diastolic dysfunction (LVDD) are early markers. The aims of this study were to evaluate (1) LVH and LVDD, using both conventional echocardiographic evaluation and Tissue Doppler Imaging (TDI), and (2) the correlation between cardiac disease and possible risk factors, in children with CKD. Methods: The study cohort comprised 34 paediatric patients with CKD and 34 healthy children (mean ± standard deviation: age 9±4.6 and 8.2±4.3 years, respectively). Thirteen (38 %) patients were in CKD stage 2, 15 (44 %) in stage 3 and six (18 %) in stage 4-5. LVH was defined as a left ventricular mass index (LVMI) of >95th percentile (38 g/h2.7). Results: Left ventricular hypertrophy was present in 13 patients (38 %). Diastolic function evaluated with TDI (E′/A′ = early/late diastolic myocardial velocity) worsened with the reduction of glomerular filtration rate (p=0.020). There was a positive correlation between LVMI and body mass index-standard deviation score (p=0.020) and a negative correlation between E′/A′ and serum phosphorus and calcium levels and their respective product (p=0.004, p=0.017, p<0.001). The relaxation index E′ was reduced in 68 % of patients. Conclusion: Based on our results, TDI is a simple procedure and would appear to be a more accurate diagnostic tool than conventional echocardiography in the early diagnosis of LVDD.