BACKGROUND: Children with advanced chronic kidney disease (CKD) frequently develop left ventricular (LV) hypertrophy. The extent of hypertrophy that results in cardiac dysfunction is unknown. Systolic function, routinely determined by ejection fraction (EF), is usually preserved in these patients. However, a decrease in EF represents an advanced cardiac dysfunction. We used cardiac magnetic resonance (CMR) and phosphorus-31 MR spectroscopy (31P MRS) to assess markers of cardiac dysfunction in young CKD patients. METHODS: Ten dialysis and ten post-transplant patients completed the study. The outcomes were peak LV myocardial circumferential strain (Ecc); myocardial T2 relaxation time and full width at half maximum (FWHM) of T2 distribution; and phosphocreatinine/adenosine triphosphate (PCr/ATP) to measure muscle energy metabolism. Healthy controls were used for comparison. RESULTS: All patients had normal EF; nine (45%) had low Ecc. Ecc was lower in dialysis versus transplant (p<0.0001) patients and inversely correlated with LV mass index, r= -0.47, p=0.04. Patients had higher T2 (p=0.056) and FWHM (p=0.01) than controls. T2 levels were positively correlated with LVM index (r=0.46, p=0.04). PCr/ATP was lower in patients than in controls (p=0.02). CONCLUSION: Young patients with advanced CKD and normal EF have early cardiac changes. Association of these abnormalities with increased left ventricular mass (LVM) index suggests development of maladaptive hypertrophy.
BACKGROUND:Children with advanced chronic kidney disease (CKD) frequently develop left ventricular (LV) hypertrophy. The extent of hypertrophy that results in cardiac dysfunction is unknown. Systolic function, routinely determined by ejection fraction (EF), is usually preserved in these patients. However, a decrease in EF represents an advanced cardiac dysfunction. We used cardiac magnetic resonance (CMR) and phosphorus-31 MR spectroscopy (31PMRS) to assess markers of cardiac dysfunction in young CKDpatients. METHODS: Ten dialysis and ten post-transplant patients completed the study. The outcomes were peak LV myocardial circumferential strain (Ecc); myocardial T2 relaxation time and full width at half maximum (FWHM) of T2 distribution; and phosphocreatinine/adenosine triphosphate (PCr/ATP) to measure muscle energy metabolism. Healthy controls were used for comparison. RESULTS: All patients had normal EF; nine (45%) had low Ecc. Ecc was lower in dialysis versus transplant (p<0.0001) patients and inversely correlated with LV mass index, r= -0.47, p=0.04. Patients had higher T2 (p=0.056) and FWHM (p=0.01) than controls. T2 levels were positively correlated with LVM index (r=0.46, p=0.04). PCr/ATP was lower in patients than in controls (p=0.02). CONCLUSION: Young patients with advanced CKD and normal EF have early cardiac changes. Association of these abnormalities with increased left ventricular mass (LVM) index suggests development of maladaptive hypertrophy.
Authors: Janaka P Wansapura; Kan N Hor; Wojciech Mazur; Robert Fleck; Sean Hagenbuch; D Woodrow Benson; William M Gottliebson Journal: J Cardiovasc Magn Reson Date: 2010-03-18 Impact factor: 5.364
Authors: Andrew Siedlecki; Margaret Foushee; John J Curtis; Robert S Gaston; Gilbert Perry; Ami E Iskandrian; Angelo M de Mattos Journal: Transplantation Date: 2007-12-27 Impact factor: 4.939
Authors: Rulan S Parekh; Laura C Plantinga; W H Linda Kao; Lucy A Meoni; Bernard G Jaar; Nancy E Fink; Neil R Powe; Josef Coresh; Michael J Klag Journal: Kidney Int Date: 2008-09-03 Impact factor: 10.612
Authors: Robert D O'Connor; Adil Bashir; W Todd Cade; Kevin E Yarasheski; Robert J Gropler Journal: J Clin Hypertens (Greenwich) Date: 2009-09 Impact factor: 3.738
Authors: Kan N Hor; Janaka Wansapura; Larry W Markham; Wojciech Mazur; Linda H Cripe; Robert Fleck; D Woodrow Benson; William M Gottliebson Journal: J Am Coll Cardiol Date: 2009-04-07 Impact factor: 24.094
Authors: Juan C Kupferman; Lisa Aronson Friedman; Christopher Cox; Joseph Flynn; Susan Furth; Bradley Warady; Mark Mitsnefes Journal: J Am Soc Nephrol Date: 2013-09-26 Impact factor: 10.121
Authors: Dulitha K Hewadikaram; Mudhitha Bandara; Amal N Pattivedana; Hiran H E Jayaweera; Kithsiri M Jayananda; W A Monica Madhavi; Aruna Pallewatte; Channa Jayasumana; Sisira Siribaddana; Janaka P Wansapura Journal: F1000Res Date: 2018-04-11
Authors: Katarina Supe-Markovina; James C Nielsen; Muzammil Musani; Laurie E Panesar; Robert P Woroniecki Journal: J Clin Hypertens (Greenwich) Date: 2016-03-14 Impact factor: 3.738