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Systolic Dysfunction in children with ESRD

Systolic Dysfunction in children with ESRD. Conventional Echo. Tissue doppler. Speckle Tracking Echo. Systolic Dysfunction. Children with ESRD: LVH and diastolic dysfunction Systolic dysfunction (SD)? Adults + CKD: SD clinical signs of cardiac failure and decreased survival 1

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Systolic Dysfunction in children with ESRD

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  1. Systolic Dysfunction in children with ESRD Conventional Echo Tissue doppler Speckle Tracking Echo

  2. Systolic Dysfunction • Children with ESRD: LVH and diastolic dysfunction Systolic dysfunction (SD)? • Adults + CKD: SD clinical signs of cardiac failure and decreased survival1 • Systolic function is thought to be preserved in children2 (measured by conventional US and TDI) • New: Speckle Tracking Echocardiography (STE) may unmask more subtle changes in systolic function • Parfrey NDT 1996 • Johnstone. Kidney Int 1996

  3. Systolic Dysfunction Conventional Echo Tissue Doppler Imaging (TDI) Speckle Tracking Echo (STE)

  4. Systolic Dysfunction Conventional Echo SF= Shortening fraction= change in diameter of LV (%) Tissue Doppler Imaging Speckle Tracking Echo (STE)

  5. SF (%)

  6. Systolic Dysfunction Conventional Echo Tissue Doppler Imaging S= Peak systolic velocity of myocard (cm/s) Speckle Tracking Echo (STE)

  7. TDI S

  8. Systolic Dysfunction Conventional Echo Tissue Doppler Imaging Speckle Tracking Echo (STE) Longitudinal strain: myocardial LV deformation (%)

  9. Speckle Tracking Echo Healthy adults Adults with hypertension

  10. Literature Adults: • STE is accurate (compared to MRI and TDI) 2 • STE and hypertension: SD before LVH3 • STE and ESRD: CKD associated with a reduction of systolic function quantified by STE 4 - Advantage: Load and angle indepenent 5 Children: • STE is accurate & reproducible in healthy children 6 • STE and ESRD: no previous studies 2. Geyer et al. JASE 2010 3. Imbalzano et al. Echocardiography 2010 4. Liu et al. Am. J. Nephrol 2011 5. Burns et al, Euro J. echocardio. 2010 6. Singh et al JASE 2010

  11. Methods • STE ESRD (n=47) vs controls (n=26) Children from Amsterdam, Nijmegen and Leuven 2. STE vs conventional US and TDI: ESRD (n=27) vs controls (n=21)all from Amsterdam 3. Intra-observer reproducibility ESRD (n=15) and controls (n=10) 4. SD and ESRD related outcomes (n=47)

  12. Results 1 • ESRD children were sign. older than controls (p=0.030), matched for BSA • Problem: more girls in the control group (p=0.004) (still measuring healthy boys) • After adjustement for age and gender by lineair regression:

  13. 2. STE vs US and TDI * Adjusted for age and gender

  14. 3. Reproducibility (n=25) Cv: coefficient of variation measures variability in relation to the mean

  15. 4. Association between SD and …. • ESRD children with SD* : 31/47 (66%) • Children with SD were sign. older, mean (sd) age: 14.3 (3.3) vs 9.5 (4.3) years (p<0.001) • No significant associations were found with duration RRT/ Tx/ dialysis or bloodpressure, iPTH, Hb and phosphate • The associations with FGF 23 and Klotho has to be evaluated *SD= systolic dysfunction defined as mean long strain < p 5 for age. Marcus et al. JASE 2011

  16. Conclusions Measured by STE children with ESRD have significantly decreased LV systolic function compared to healthy matched controls STE is more sensitive in detection of SD than conventional echocardiography and TDI Longitudinal studies are necessary to evaluate the progression of cardiac dysfunction in these children

  17. Questions

  18. Correlation DD and SD

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