Key result
Abnormal myocardial strain affects >60% of pediatric advanced CKD patients and tracks with higher LVMI.
Why the study?
Children with advanced CKD have a high burden of CVD, but the relationship between CKD and myocardial morphology and function assessed by CMR is not well characterized.
Cross-Sectional (n=47)
Yes
Cardiac magnetic resonance imaging reveals a high prevalence of subclinical systolic dysfunction (abnormal myocardial strain) that is associated with increased left ventricular mass index in pediatric patients with advanced pre-dialysis CKD.
Should not yet change practice in pediatric advanced CKD; hypothesis-generating for CMR strain in LV remodeling assessment.
BACKGROUND: Children with advanced chronic kidney disease (CKD) have a high burden of cardiovascular disease (CVD). Left ventricular hypertrophy (LVH) and abnormal myocardial strain are prevalent in CKD patients and confer increased cardiovascular morbidity. While echocardiography is conventionally used to assess myocardial function, cardiovascular magnetic resonance imaging (CMR) provides superior assessment of myocardial morphology and function, including myocardial strain. We conducted an exploratory analysis of the CMR features of children with advanced CKD in the Chronic Kidney Disease in Children (CKiD) study to evaluate the relationship between CKD and CVD severity. METHODS: underwent CMR. Left ventricular mass indexed to body surface area (LV mass index), global peak longitudinal strain (GLS), and global peak circumferential strain (GCS) were the primary continuous outcomes. We quantified associations between clinical/demographic risk factors with LV mass index, GLS, and GCS using linear regression, and utilized a variant of stepwise regression to identify combinations of independent variables that were most associated with the primary outcomes. RESULTS: ). LVH was prevalent at 13%. GLS and GCS > 95th percentile of published normative thresholds was prevalent at 60% and 68%, respectively. Only 6% of participants had clinically significant abnormally low absolute GLS (< 15). Lower GLS and GCS were independently associated with higher LV mass index. CONCLUSIONS: Myocardial strain > 95th percentile of published normal thresholds on CMR was highly prevalent and related to higher LV mass index in the CKiD cohort with advanced CKD.
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Reyes et al. (2026) conducted a cross-sectional in Advanced chronic kidney disease (n=47). Advanced chronic kidney disease vs. Published healthy normative thresholds was evaluated on Left ventricular mass index, global peak longitudinal strain (GLS), and global peak circumferential strain (GCS) assessed by cardiovascular magnetic resonance. In pediatric patients with advanced chronic kidney disease, abnormal myocardial strain was highly prevalent (>60% of patients) and lower strain was independently associated with a higher left ventricular mass index.
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