Key result
3D echocardiography yields ~15-point lower LVEF compared to 2D echocardiography.
Why the study?
This study aimed to assess LV myocardial dysfunction in children with end-stage CKD using 2D and 3D speckle-tracking echocardiography for the early detection of subclinical systolic impairment.
Does 2D and 3D speckle-tracking echocardiography improve early detection of subclinical left ventricular systolic dysfunction compared to conventional echocardiography in children with end-stage kidney disease on maintenance hemodialysis?
Cross-Sectional (n=20)
No
Does 2D and 3D speckle-tracking echocardiography improve early detection of subclinical left ventricular systolic dysfunction compared to conventional echocardiography in children with end-stage kidney disease on maintenance hemodialysis?
In children with end-stage kidney disease on chronic hemodialysis, 2D and 3D speckle-tracking echocardiography can detect subclinical left ventricular systolic dysfunction and lower 3D ejection fraction even when conventional 2D ejection fraction appears preserved.
Conventional 2D LVEF may miss subclinical LV dysfunction in pediatric hemodialysis patients; leaves open whether 3D or strain-guided management improves outcomes beyond this 20-patient cohort.
Objective: We assessed left ventricular (LV) myocardial dysfunction in children with end-stage chronic kidney disease (CKD) using two-dimensional (2D) and three-dimensional (3D) speckle-tracking echocardiography (STE) for early detection of subclinical systolic impairment. Methods: This prospective observational study included 20 children with end-stage CKD receiving maintenance hemodialysis for at least 12 months were enrolled. All participants completed the study. Inclusion criteria were age <18 years and regular hemodialysis for ≥1 year. Patients with known congenital or acquired structural heart disease were excluded. LV ejection fraction (EF) measured by 2D and 3D echocardiography; 2D global longitudinal strain (GLS); and 3D global peak systolic longitudinal strain (GPSL) Results: The mean 2D EF was 59 ± 7.2%, whereas 3D EF was significantly lower 43.8 ± 14.8%; (P = 0.001). Mean 2D GLS and 3D GPSL were −14.3 ± 2.4% and −13.7 ± 2.7%, respectively, both substantially less negative than normal pediatric values, indicating subclinical systolic dysfunction. Conclusion: Children with CKD on maintenance hemodialysis exhibit early LV systolic dysfunction detectable by 2D and 3D STE despite preserved EF on conventional echocardiography. Speckle-tracking imaging provides a sensitive, noninvasive method for early detection of uremic cardiomyopathy and should be integrated into routine cardiac assessment in pediatric CKD.
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Mohammed et al. (2026) conducted a cross-sectional in End-stage kidney disease (ESKD) on maintenance hemodialysis (n=20). Three-dimensional speckle-tracking echocardiography (3D-STE) vs. Two-dimensional echocardiography and 2D speckle-tracking echocardiography (2D-STE) was evaluated on Left ventricular ejection fraction (LVEF) (p=0.001). Three-dimensional echocardiography yielded a significantly lower mean LVEF than 2D echocardiography (43.8% vs 59%, P=0.001), while 2D and 3D strain detected impaired deformation (-14.3% and -13.7%).
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