Published Online
on February 3, 2003

A more recent version of this article appeared on February 18, 2003

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Submitted on August 6, 2002
Revised on November 4, 2002
Accepted on November 4, 2002

Left Ventricular Mass and Systolic Performance in Pediatric Patients With Chronic Renal Failure

Mark M. Mitsnefes MD^*, Thomas R. Kimball MD, Sandra A. Witt RDCS, Betty J. Glascock RDCS, Philip R. Khoury MS, and Stephen R. Daniels MD, PhD

From the Divisions of Nephrology and Hypertension (M.M.M.) and Cardiology (T.R.K., S.A.W., B.J.G., P.R.K., S.R.D.), Cincinnati Children's Hospital Research Foundation, Cincinnati, Ohio.

^* To whom correspondence should be addressed. E-mail: mark.mitsnefes{at}CCHMC.org.

Background--Children with chronic renal disease have a high prevalence of left ventricular hypertrophy (LVH), which is thought to be adaptive to improve contractility and lower wall stress in the face of increased afterload and preload. The aim of this study was to determine the association between LV mass, LV performance, and LV contractility in children with chronic renal insufficiency (CRI) and children undergoing chronic dialysis.

Methods and Results--Twenty-five children with CRI, 12 undergoing chronic dialysis, and 24 controls had echocardiographic evaluation during rest and peak exercise. LV performance was assessed by calculation of shortening fraction and heart rate-corrected velocity of circumferential fiber shortening (VCF). Contractility (VCF difference) was determined based on the relation between VCF and end-systolic wall stress. Contractile reserve was assessed by the difference between contractility at rest and peak exercise. The dialysis group had higher LVM index than the group with CRI (42.9±10.3 versus 29.9±9.4 g/m^2.7, P<0.001). Both groups had higher LVM index compared with controls (22.2±6.1 g/m^2.7, P<0.001). At rest, the CRI and dialysis groups had significantly higher VCF_c (P<0.001) and VCF difference (P<0.05) and significantly lower wall stress (P<0.01) compared with the control group. Dialysis patients had significantly lower contractile reserve compared with the control group (P<0.03).

Conclusions--These results indicate that children with CRI and undergoing chronic dialysis have increased LVM, LV performance, and contractility at rest. However, dialysis patients have diminished contractile reserve during exercise, which might be an indicator for the development of more severe systolic dysfunction over time.

Key words: pediatrics • kidney • cardiovascular diseases • hypertrophy • contractility

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