Abstract 9613: Left Ventricular Dyssynchrony (LVD) in Children With End-Stage Renal Disease
Introduction: Left ventricular dyssynchrony (LVD) adversely affects systolic performance and regional myocardial perfusion and metabolism. The association between LVD and end-stage renal disease (ESRD) in children has not been previously investigated.
Hypothesis: 1. LVD in children with ESRD would be significantly increased compared to controls 2. Children undergoing peritoneal (PD) and hemodialysis (HD) would have comparable LVD.
Methods: Prospective observational study in which real-time 3-D echocardiographic data were acquired in 27 stable children with ESRD (13 PD and 14 HD) and 29 normal controls. For children with HD, data were acquired before and after a HD session. Dyssynchrony index (SDI) was defined as standard deviation of the time to reach minimum regional volume for 16, 12 and 6 segments. SDI was normalized to duration of cardiac cycle (SDIp). Left ventricular mass (LVM) was obtained from the short-axis view on M-mode echocardiography and was normalized to height2.7 (LVM index). Means were compared by paired t test.
Results: The mean age of children with ESRD was higher than that of controls (13.8 vs 11.3 years; p= 0.012) while gender distribution, height, weight and body surface areas were comparable. SV, ESV, SDI, SDIp, LVM and LVM index were significantly higher in those with ESRD (Table). Demographics and HR were comparable between HD and PD subgroups while EDV, ESV, SV, SDI 16 and 12 segments, SDIp 16 segments and LVM were significantly higher in the HD group (P <0.05). SDI and SDIp 16 segments significantly improved after a HD session (p <0.05); LVM and LVM index remained unchanged. There was no correlation between SDIp and LVM.
Conclusions: Children with ESRD have significant LVD and increased LVM compared to controls. LVD and increased LVM in those undergoing HD and the improvement in synchrony following a HD session suggest that volume may modulate LVD. We speculate that LVD in children with ESRD may have pathogenic implications.
- © 2011 by American Heart Association, Inc.