Adrienn Bárczi1, Bálint Lakatos2, Orsolya Cseprekál3, Éva Kis4, Attila Kovács2, László Berta1, Attila Szabó1, Béla Merkely2, György S. Reusz1
1 Semmelweis University, 1st Department of Pediatrics, Budapest, Hungary
2 Semmelweis University, Heart and Vascular Center, Budapest, Hungary
3 Semmelweis University, Department of Transplantion and Surgery, Budapest, Hungary
4 Gottsegen György Hungarian Institute of Cardiology, Budapest, Hungary
Introduction: Children with chronic kidney disease are at elevated risk of cardiovascular (CV) morbidity and mortality. Renal transplantation is associated with improved survival, however CV risk is still several times higher than in the general population. As major CV events are rare in children early subclinical changes of the heart and vessels should be assessed by non- invasive methods. Pulse wave velocity (PWV) is an independent and strong marker of arterial stiffness; further myocardial strain measured by speckle tracking echocardiography can be useful for detecting early ventricular abnormalities.
Aims: The aim of the study was to detect cardiac and vascular dysfunction in kidney transplanted pediatric patients.
Method: 41 kidney transplanted children (KTX) (mean age: 13,8 ±3,3 years, 18 males) and 39 age-matched healthy controls were enrolled into the study (mean age: 13,7± 3,5 years, 22 males). Carotid-femoral PWV was recorded by applanation tonometry. Conventional and speckle tracking echocardiography was perfomed in all participants using apical 2, 3 and 4 chamber view for strain measurements.
Results: Carotid-femoral PWV was significantly higher in the KTX patients than the control group (PWV Z-score 0,51±1,08 vs. 0,01± 0,92; p<0,05). Systolic parameters were well-preserved following transplantation, while KTX group has significantly higher left ventricular mass index (LVMI; 36,2± 7,5 vs. 28,2± 6,0 g/m2 p<0,001) and significantly lower early diastolic strain rate (LSrE: 1,4±0,4 vs. 1,6±0,4 1/s, p<0,05) comparing to healthy children. Impaired LSrE showed a negative correlation with the time since transplantation. (r=-0,344, p<0,05)
Conclusion: Following kidney transplantion children have decreased aortic elasticity with a preserved systolic funcion, however signs of early diastolic dysfunction are already present. Speckle tracking echocardiography is a useful tool to reveal early myocardial dysfuncion in pediatric kidney transplant recipients.
Supported by the ÚNKP-18-3-I-SE-31 New National Excellence Program of the Ministry of Human Capacities , NKFI K124549
Doctoral School: Clinical Medicine
Program: Prevention of chronic pediatric diseases
Supervisor: Dr. György S. Reusz