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      Impaired longitudinal deformation measured by speckle-tracking echocardiography in children with end-stage renal disease

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          Abstract

          Background

          Left ventricular dysfunction is an important co-morbidity of end-stage renal disease (ESRD) and is associated with a poor prognosis in the adult population. In pediatric ESRD, left ventricular function is generally well preserved, but limited information is available on early changes in myocardial function. The aim of this study was to investigate myocardial mechanics in pediatric patients with ESRD using speckle-tracking echocardiography (STE).

          Methods

          Echocardiographic studies, including M-mode, tissue Doppler imaging (TDI) and STE, were performed in 19 children on dialysis, 17 transplant patients and 33 age-matched controls. Strain measurements were performed from the apical four-chamber and the short axis view, respectively.

          Results

          The interventricular and left ventricular posterior wall thickness was significantly increased in dialysis and transplant patients compared to healthy controls. No significant differences were found in shortening fraction, ejection fraction and systolic tissue Doppler velocities. Dialysis and transplant patients had a decreased mean longitudinal strain compared to healthy controls, with a mean difference of 3.1 [95 % confidence interval (CI) 2.0–4.4] and 2.7 (95 % CI 1.2–4.2), respectively. No differences were found for radial and circumferential strain.

          Conclusions

          Speckle-tracking echocardiography may reveal early myocardial dysfunction in the absence of systolic dysfunction measured by conventional ultrasound or TDI in children with ESRD.

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          Most cited references38

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          Guidelines and standards for performance of a pediatric echocardiogram: a report from the Task Force of the Pediatric Council of the American Society of Echocardiography.

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            Clinical and echocardiographic disease in patients starting end-stage renal disease therapy.

            End-stage renal disease (ESRD) patients have a high cardiovascular mortality rate. Precise estimates of the prevalence, risk factors and prognosis of different manifestations of cardiac disease are unavailable. In this study a prospective cohort of 433 ESRD patients was followed from the start of ESRD therapy for a mean of 41 months. Baseline clinical assessment and echocardiography were performed on all patients. The major outcome measure was death while on dialysis therapy. Clinical manifestations of cardiovascular disease were highly prevalent at the start of ESRD therapy: 14% had coronary artery disease, 19% angina pectoris, 31% cardiac failure, 7% dysrhythmia and 8% peripheral vascular disease. On echocardiography 15% had systolic dysfunction, 32% left ventricular dilatation and 74% left ventricular hypertrophy. The overall median survival time was 50 months. Age, diabetes mellitus, cardiac failure, peripheral vascular disease and systolic dysfunction independently predicted death in all time frames. Coronary artery disease was associated with a worse prognosis in patients with cardiac failure at baseline. High left ventricular cavity volume and mass index were independently associated with death after two years. The independent associations of the different echocardiographic abnormalities were: systolic dysfunction-older age and coronary artery disease; left ventricular dilatation-male gender, anemia, hypocalcemia and hyperphosphatemia; left ventricular hypertrophy-older age, female gender, wide arterial pulse pressure, low blood urea and hypoalbuminemia. We conclude that clinical and echocardiographic cardiovascular disease are already present in a very high proportion of patients starting ESRD therapy and are independent mortality factors.
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              Speckle-tracking echocardiography: a new technique for assessing myocardial function.

              Speckle-tracking echocardiography has recently emerged as a quantitative ultrasound technique for accurately evaluating myocardial function by analyzing the motion of speckles identified on routine 2-dimensional sonograms. It provides non-Doppler, angle-independent, and objective quantification of myocardial deformation and left ventricular systolic and diastolic dynamics. By tracking the displacement of the speckles during the cardiac cycle, strain and the strain rate can be rapidly measured offline after adequate image acquisition. Data regarding the feasibility, accuracy, and clinical applications of speckle-tracking echocardiography are rapidly accumulating. This review describes the fundamental concepts of speckle-tracking echocardiography, illustrates how to obtain strain measurements using this technique, and discusses their recognized and developing clinical applications.
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                Author and article information

                Contributors
                +31-20-5666152 , maikevanhuis@gmail.com
                Journal
                Pediatr Nephrol
                Pediatr. Nephrol
                Pediatric Nephrology (Berlin, Germany)
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                0931-041X
                1432-198X
                17 May 2016
                17 May 2016
                2016
                : 31
                : 1499-1508
                Affiliations
                [ ]Department of Pediatric Nephrology, Emma Children’s Hospital, Academic Medical Center (AMC) Amsterdam/University of Amsterdam, Amsterdam, The Netherlands
                [ ]Pediatric Clinical Research Office, Emma Children’s Hospital, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
                [ ]Department of Pediatric Nephrology, University Hospital Leuven, Leuven, Belgium
                [ ]Department of Pediatric Cardiology, University Hospital Leuven, Leuven, Belgium
                [ ]Department of Pediatric Nephrology, University Medical Center (UMC) St. Radboud/Radboud University, Nijmegen, The Netherlands
                [ ]Department of Pediatric Cardiology, UMC St. Radboud/Radboud University, Nijmegen, The Netherlands
                [ ]Department of Pediatric Nephrology, Wilhelmina Children’s Hospital, UMC Utrecht/Utrecht University, Utrecht, The Netherlands
                [ ]Department of Pediatric Cardiology, Emma Children’s Hospital, AMC Amsterdam/University of Amsterdam, Amsterdam, The Netherlands
                [ ]Cardiology, The Hospital for Sick Children, The University of Toronto, Toronto, ON Canada
                Article
                3362
                10.1007/s00467-016-3362-0
                4943969
                27189482
                e8626be4-55c1-470f-879a-e329999ed998
                © The Author(s) 2016

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                : 14 September 2015
                : 13 February 2016
                : 15 February 2016
                Categories
                Original Article
                Custom metadata
                © IPNA 2016

                Nephrology
                cardiovascular imaging,pediatric,systolic dysfunction,longitudinal strain,children
                Nephrology
                cardiovascular imaging, pediatric, systolic dysfunction, longitudinal strain, children

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