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. 2022 Oct;37(10):2489-2501.
doi: 10.1007/s00467-022-05422-7. Epub 2022 Feb 15.

Subclinical cardiac dysfunction in pediatric kidney transplant recipients identified by speckle-tracking echocardiography

Adrienn Bárczi #  1 , Bálint Károly Lakatos #  2 , Mónika Szilágyi  2 , Éva Kis  3 , Orsolya Cseprekál  4 , Alexandra Fábián  2 , Attila Kovács  2 , Attila J Szabó  1 , Béla Merkely  2 , Paolo Salvi  5 , György S Reusz  6
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Subclinical cardiac dysfunction in pediatric kidney transplant recipients identified by speckle-tracking echocardiography

Adrienn Bárczi et al. Pediatr Nephrol. 2022 Oct.

Abstract

Background: Kidney transplantation (KTx) improves prognosis in children with kidney failure; still, these patients are prone to cardiovascular damage due to multiple risk factors. Our aim was to assess myocardial structure and function in pediatric KTx by conventional and speckle-tracking echocardiography (STE) in association with established cardiovascular risk factors.

Methods: Forty-two KTx and 39 healthy age- and gender-matched children were evaluated. KTx recipients were further categorized according to the control of hypertension assessed by 24-h ambulatory blood pressure monitoring (ABPM). Subjects underwent pulse wave velocity (PWV) measurement, conventional echocardiography, and 2-dimensional STE. Left and right ventricular (LV, RV) global longitudinal strain (GLS), and LV circumferential strain (GCS) were measured. Glomerular filtration rate (eGFR) was calculated according to the Schwartz formula.

Results: KTx patients had increased blood pressure and arterial stiffness. LV ejection fraction (EF) was preserved along with elevated LV mass index (LVMi) while LVGLS was significantly lower, whereas LVGCS and RVGLS were increased in KTx. Uncontrolled hypertensives had lower LVGLS compared to those with controlled hypertension. Using multiple forward stepwise regression analysis, 24-h SBP and relative wall thickness (RWT) were independent determinants of LVMi, whereas antihypertensive therapy, eGFR, and HOMA-IR were independent determinants of LVGLS.

Conclusions: Cardiac morphology and function show distinct changes after KTx. Along with comparable ventricular volumes, LV hypertrophy and subclinical myocardial dysfunction are present. Control of hypertension and kidney graft function are major factors of LV performance. STE may be useful to reveal early myocardial dysfunction in pediatric KTx. A higher resolution version of the Graphical abstract is available as Supplementary information.

Keywords: Cardiovascular disease; Hypertension; Kidney transplant children; Longitudinal strain; Speckle-tracking echocardiography.

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Conflict of interest statement

Paolo Salvi has served as a consultant for DiaTecne srl.

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