Key result
Pediatric kidney transplant recipients demonstrated significantly lower left ventricular global longitudinal strain (-20.5% vs. -22.0%) and higher ventricular volumes compared to healthy controls.
Why the study?
Pediatric kidney transplant recipients have an increased cardiovascular disease risk, but distinct functional and morphological changes undetectable by conventional methods might be unveiled by 3D echocardiography.
Does pediatric kidney transplantation associate with changes in left and right ventricular morphology and mechanics compared to healthy controls?
Cross-Sectional (n=148)
No
Does pediatric kidney transplantation associate with changes in left and right ventricular morphology and mechanics compared to healthy controls?
Absolute Event Rate: -20.5% vs -22%
p-value: p=<0.001
Pediatric kidney transplant recipients exhibit subclinical changes in both left and right ventricular morphology and mechanics detectable by 3D echocardiography, with right ventricular impairment correlating with pre-transplant dialysis duration.
Background Kidney transplantation (KTX) markedly improves prognosis in pediatric patients with end-stage kidney failure. Still, these patients have an increased risk of developing cardiovascular disease due to multiple risk factors. Three-dimensional (3D) echocardiography allows detailed assessment of the heart and may unveil distinct functional and morphological changes in this patient population that would be undetectable by conventional methods. Accordingly, our aim was to examine left- (LV) and right ventricular (RV) morphology and mechanics in pediatric KTX patients using 3D echocardiography. Materials and methods Pediatric KTX recipients ( n = 74) with median age 20 (14–26) years at study enrollment (43% female), were compared to 74 age and gender-matched controls. Detailed patient history was obtained. After conventional echocardiographic protocol, 3D loops were acquired and measured using commercially available software and the ReVISION Method. We measured LV and RV end-diastolic volumes indexed to body surface area (EDVi), ejection fraction (EF), and 3D LV and RV global longitudinal (GLS) and circumferential strains (GCS). Results Both LVEDVi (67 ± 17 vs. 61 ± 9 ml/m 2 ; p < 0.01) and RVEDVi (68 ± 18 vs. 61 ± 11 ml/m 2 ; p < 0.01) were significantly higher in KTX patients. LVEF was comparable between the two groups (60 ± 6 vs. 61 ± 4%; p = NS), however, LVGLS was significantly lower (−20.5 ± 3.0 vs. −22.0 ± 1.7%; p < 0.001), while LVGCS did not differ (−29.7 ± 4.3 vs. −28.6 ± 10.0%; p = NS). RVEF (59 ± 6 vs. 61 ± 4%; p < 0.05) and RVGLS (−22.8 ± 3.7 vs. −24.1 ± 3.3%; p < 0.05) were significantly lower, however, RVGCS was comparable between the two groups (−23.7 ± 4.5 vs. −24.8 ± 4.4%; p = NS). In patients requiring dialysis prior to KTX ( n = 64, 86%) RVGCS showed correlation with the length of dialysis ( r = 0.32, p < 0.05). Conclusion Pediatric KTX patients demonstrate changes in both LV and RV morphology and mechanics. Moreover, the length of dialysis correlated with the contraction pattern of the right ventricle.
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Ladányi et al. (2023) conducted a cross-sectional in End-stage kidney disease (pediatric kidney transplant recipients) (n=148). Pediatric kidney transplantation vs. Age- and gender-matched healthy controls was evaluated on Left ventricular global longitudinal strain (LVGLS) (p=<0.001). Pediatric kidney transplant recipients demonstrated significantly lower left ventricular global longitudinal strain (-20.5% vs. -22.0%) and higher ventricular volumes compared to healthy controls.
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