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Reduced Systolic Myocardial Function in Children with Chronic Renal Insufficiency

Marcello Chinali^*, Giovanni de Simone^*, Maria Chiara Matteucci, Stefano Picca, Antonio Mastrostefano, Ali Anarat, Salim Çaliskan, Nikola Jeck^||, Thomas J. Neuhaus^¶, Amira Peco-Antic^**, Licia Peruzzi, Sara Testa, Otto Mehls, Elke Wühl, Franz Schaefer for the ESCAPE Trial Group

^* Department of Clinical and Experimental Medicine, and "Federico II" University Hospital, Naples, Italy; Division of Pediatric Nephrology, Bambino Gesú Children’s Research Hospital, Rome, Italy; Department of Pediatric Nephrology, Cukurova University School of Medicine, Adana, Turkey; Department of Pediatrics, Department of Pediatrics, Cerrahpasa Medical Faculty University of Istanbul, Turkey; ^|| Pediatric Nephrology, University Children’s Hospital Marburg, Marburg, Germany; ^¶ Division of Nephology, University Children’s Hospital Zurich, Zurich, Switzerland; ^** Department of Pediatrics, University Children’s Hospital, Belgrade, Serbia; Division of Nephrology, University Children’s Hospital, Torino, Italy; Division of Pediatrics and Neonatology, Azienda Ospedaliera Istituti Clinici di Perfezionamento Milano, Milan, Italy; and Pediatric Nephrology Division, University of Heidelberg, Heidelberg, Germany

Address correspondence to: Dr. Giovanni de Simone, Echocardiography Laboratory, Department of Clinical and Experimental Medicine, "Federico II" University Hospital School of Medicine, Ed.1, Via Sergio Pansini 5, 80131, Napoli, Italy. Phone: +81-746-2013; Fax: +81-546-6152; E-mail: simogi{at}unina.it

Received for publication July 4, 2006. Accepted for publication November 13, 2006.

Increased left ventricular (LV) mass in children with chronic renal insufficiency (CRI) might be adaptive to sustain myocardial performance in the presence of increased loading conditions. It was hypothesized that in children with CRI, LV systolic function is impaired despite increased LV mass (LVM). Standard echocardiograms were obtained in 130 predialysis children who were aged 3 to 18 yr (59% boys) and had stages II through IV chronic kidney disease and in 130 healthy children of similar age, gender distribution, and body build. Systolic function was assessed by measurement of fractional shortening at the endocardial (eS) and midwall (mS) levels and computation of end-systolic stress (myocardial afterload). The patients with CRI exhibited a 6% lower eS (33.1 ± 5.5 versus 35.3 ± 6.1%; P < 0.05) and 10% lower mS (17.8 ± 3.1 versus 19.7 ± 2.7%; P < 0.001) than control subjects in the presence of significantly elevated BP, increased LVM, and more concentric LV geometry. Whereas the decreased eS was explained entirely by augmented end-systolic stress, mS remained reduced after correction for myocardial afterload. The prevalence of subclinical systolic dysfunction as defined by impaired mS was more than five-fold higher in patients with CRI compared with control subjects (24.6 versus 4.5%; P < 0.001). Systolic dysfunction was most common (48%) in patients with concentric hypertrophy and associated with lower hemoglobin levels. CRI in children is associated with impaired intrinsic LV contractility, which parallels increased LVM.

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Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673