Abstract Background: Cardiovascular complications are the leading cause of mortality in pediatric patients with chronic kidney disease (CKD). Echocardiographic assessment of diastolic function in CKD has been limited to spectral and tissue Doppler imaging, known to be less reliable techniques in pediatrics. Two-dimensional Speckle tracking echocardiography (2DST) derived left atrial (LA) strain has recently been confirmed as a robust measure of diastolic function. Objectives: To investigate LA strain role in diastolic assessment of children at different stages of CKD. Methods: From February 2019 to July 2022, 55 CKD patients without cardiovascular symptoms and 55 controls were evaluated by standard and 2DST echocardiograms. The level of significance was set at 5% (p<0.05). Results: Patients and controls had similar age [9.78 (0.89 – 17.54) vs. 10.72 (1.03 –18,44) years; p = 0.41] and gender (36M:19F vs. 34M:21F; p=0.84). There were 25 non-dialysis patients and 30 dialysis patients. Left ventricular ejection fraction was ≥ 55% in all of them. Comparing CKD and controls, LA reservoir strain was lower (48.22±10.62% vs. 58.52±10.70%) and LA stiffness index was higher [0.14 (0.08–0.48)%-1 vs. 0.11 (0.06–0.23) %-1]; p<0.0001. LV hypertrophy was associated with lower LA reservoir strain (42.05±8.74% vs. 52.99±9.52%), higher LA stiffness [0.23(0.11 – 0.48)%-1 vs. 0.13 (0.08–0.23) %-1 and filling indexes (2.39±0.63 cm/s x %-1 vs. 1.74±0.47 cm/s x %-1; p<0.0001. Uncontrolled hypertension was associated with lower LA reservoir strain (41.9±10.6% vs. 50.6±9.7; p=0.005). Conclusions: LA strain proved to be a feasible tool in the assessment of pediatric CKD patients and was associated with known cardiovascular risk factors. Background . (CKD) imaging pediatrics Twodimensional Two dimensional DST (2DST (LA Objectives Methods 201 2022 5 echocardiograms p<0.05. p005 p<0.05 0 05 (p<0.05) Results 9.78 978 9 78 [9.7 0.89 089 89 (0.8 17.54 1754 17 54 vs 1072 10 72 10.7 1.03 103 1 03 (1.0 –18,44 1844 18 44 years 0.41 041 41 36M19F MF 36M 19F M F 34M21F 34M 21F 34M:21F p=0.84. p084 p=0.84 84 p=0.84) 2 nondialysis non 3 them 48.22±10.62% 48221062 48 22 62 (48.22±10.62 58.52±10.70% 58521070 58 52 70 0.14 014 14 [0.1 0.08–0.48%1 0080481 0.08–0.48 % 08 (0.08–0.48)%- 011 11 0.1 0.06–0.23 006023 06 23 (0.06–0.23 %1 %-1] p00001 0001 p<0.0001 42.05±8.74% 4205874 42 8 74 (42.05±8.74 52.99±9.52%, 5299952 52.99±9.52% , 99 52.99±9.52%) 0.230.11 023011 0.23 [0.23(0.1 0.48%1 0481 0.48 0.48)%- 013 13 0.08–0.23 008023 (0.08–0.23 %- 2.39±0.63 239063 39 63 (2.39±0.6 cms cm s 174047 47 1.74±0.4 41.9±10.6% 419106 6 (41.9±10.6 50.6±9.7 50697 50 7 p=0.005. p0005 p=0.005 005 p=0.005) Conclusions factors (CKD 20 202 p00 p<0.0 (p<0.05 9.7 97 [9. 0.8 (0. 17.5 175 107 10. 1.0 (1. –18,4 184 4 0.4 04 p08 p=0.8 48.22±10.62 4822106 (48.22±10.6 58.52±10.70 5852107 01 [0. 0.08–0.48% 008048 0.08–0.4 (0.08–0.48)% 0. 0.06–0.2 00602 (0.06–0.2 p0000 000 p<0.000 42.05±8.74 420587 (42.05±8.7 529995 52.99±9.52 230 0.230.1 02301 023 0.2 [0.23(0. 0.48% 048 0.48)% 0.08–0.2 00802 (0.08–0.2 2.39±0.6 23906 (2.39±0. 17404 1.74±0. 41.9±10.6 41910 (41.9±10. 50.6±9. 5069 p000 p=0.00 00 p0 p<0. (p<0.0 9. [9 (0 17. 1. (1 –18, p=0. 48.22±10.6 482210 (48.22±10. 58.52±10.7 585210 [0 00804 0.08–0. (0.08–0.48) 0.06–0. 0060 (0.06–0. p<0.00 42.05±8.7 42058 (42.05±8. 52999 52.99±9.5 0.230. 0230 02 [0.23(0 0.48) 0080 (0.08–0. 2.39±0. 2390 (2.39±0 1740 1.74±0 41.9±10. 4191 (41.9±10 50.6±9 506 p=0.0 p<0 (p<0. [ ( –18 p=0 48.22±10. 48221 (48.22±10 58.52±10. 58521 0.08–0 (0.08–0.48 0.06–0 006 (0.06–0 42.05±8. 4205 (42.05±8 5299 52.99±9. 0.230 [0.23( 008 (0.08–0 2.39±0 239 (2.39± 174 1.74± 41.9±10 419 (41.9±1 50.6± p< (p<0 –1 p= 48.22±10 4822 (48.22±1 58.52±10 5852 0.08– (0.08–0.4 0.06– (0.06– 42.05±8 420 (42.05± 529 52.99±9 [0.23 (0.08– 2.39± (2.39 1.74 41.9±1 (41.9± 50.6 (p< 48.22±1 482 (48.22± 58.52±1 585 0.08 0.06 (0.06 42.05± (42.05 52.99± [0.2 (0.08 2.39 (2.3 1.7 41.9± (41.9 50. (p 48.22± (48.22 58.52± 0.0 (0.0 42.05 (42.0 52.99 2.3 (2. 41.9 (41. 48.22 (48.2 58.52 42.0 (42. 52.9 2. (2 41. (41 48.2 (48. 58.5 42. (42 52. (4 48. (48 58.
Resumo Fundamento: As complicações cardiovasculares são a principal causa de morte em pacientes pediátricos com doença renal crônica (DRC). A avaliação ecocardiográfica da função diastólica na DRC tem se limitado à avaliação espectral por Doppler espectral e por Doppler tecidual, técnicas sabidamente menos confiáveis na pediatria. O strain do átrio esquerdo (AE) pela técnica do speckle tracking bidimensional (2DST) foi recentemente confirmada como uma medida robusta da função diastólica. Objetivos: Investigar o papel do strain do AE na avaliação da função diastólica de crianças em diferentes estágios da DRC. Métodos: De fevereiro de 2019 a julho de 2022, 55 pacientes com DRC sem sintomas cardiovasculares e 55 controles foram avaliados por ecocardiografia convencional e por ecocardiografia com 2DST. O nível de significância adotado foi de 5% (p < 0,05). Resultados: Pacientes e controles tinham idade similares [9,78 (0,89 – 17,54) vs. 10,72 (1,03 –18,44) anos; p = 0,41] e sexo (36M:19F vs. 34M:21F; p = 0,84) similares. Havia 25 pacientes não dialíticos e 30 pacientes dialíticos. A fração de ejeção do ventrículo esquerdo foi ≥ 55% em todos. Em comparação aos controles, os pacientes com DRC apresentaram strain de reservatório mais baixo (48,22±10,62% vs. 58,52±10,70%) e índice de rigidez do AE mais alto [0,14 (0,08–0,48)%-1 vs. 0,11 (0,06–0,23) %-1]; p<0,0001. A hipertrofia ventricular esquerda associou-se com um strain de reservatório mais baixo (42,05±8,74% vs. 52,99±9,52%), e valores mais altos de índice de rigidez [0,23 (0,11 – 0,48)%-1 vs. 0,13 (0,08–0,23) %-1 e de índice de enchimento do AE (2,39±0,63 cm/s x %-1 vs. 1,74±0,47 cm/s x %-1; p<0,0001). Hipertensão não controlada associou-se com strain de reservatório do AE mais baixo (41,9±10,6% vs. 50,6±9,7; p=0,005). Conclusão: O strain do AE mostrou-se uma ferramenta útil na avaliação de pacientes pediátricos com DRC e associado com fatores de risco cardiovasculares conhecidos. Fundamento . (DRC) tecidual pediatria (AE 2DST DST (2DST Objetivos Métodos 201 2022 5 0,05. 005 0,05 0 05 0,05) Resultados 9,78 978 9 78 [9,7 0,89 089 89 (0,8 17,54 1754 17 54 vs 1072 10 72 10,7 1,03 103 1 03 (1,0 –18,44 1844 18 44 anos 0,41 041 41 36M19F MF 36M 19F M F 34M21F 34M 21F 34M:21F 0,84 084 84 2 3 todos 48,22±10,62% 48221062 48 22 62 (48,22±10,62 58,52±10,70% 58521070 58 52 70 0,14 014 14 [0,1 0,08–0,48%1 0080481 0,08–0,48 % 08 (0,08–0,48)%- 011 11 0,1 0,06–0,23 006023 06 23 (0,06–0,23 %1 %-1] p00001 0001 p<0,0001 associouse associou 42,05±8,74% 4205874 42 8 74 (42,05±8,74 52,99±9,52%, 5299952 52,99±9,52% , 99 52,99±9,52%) 0,23 023 [0,2 (0,1 0,48%1 0481 0,48 0,48)%- 013 13 0,08–0,23 008023 (0,08–0,23 %- 2,39±0,63 239063 39 63 (2,39±0,6 cms cm s 174047 47 1,74±0,4 p<0,0001) 41,9±10,6% 419106 6 (41,9±10,6 50,6±9,7 50697 50 7 p=0,005. p0005 p=0,005 p=0,005) Conclusão mostrouse mostrou conhecidos (DRC 20 202 00 0,0 9,7 97 [9, 0,8 (0, 17,5 175 107 10, 1,0 (1, –18,4 184 4 0,4 04 48,22±10,62 4822106 (48,22±10,6 58,52±10,70 5852107 01 [0, 0,08–0,48% 008048 0,08–0,4 (0,08–0,48)% 0, 0,06–0,2 00602 (0,06–0,2 p0000 000 p<0,000 42,05±8,74 420587 (42,05±8,7 529995 52,99±9,52 0,2 02 0,48% 048 0,48)% 0,08–0,2 00802 (0,08–0,2 2,39±0,6 23906 (2,39±0, 17404 1,74±0, 41,9±10,6 41910 (41,9±10, 50,6±9, 5069 p000 p=0,00 9, [9 (0 17, 1, (1 –18, 48,22±10,6 482210 (48,22±10, 58,52±10,7 585210 [0 00804 0,08–0, (0,08–0,48) 0,06–0, 0060 (0,06–0, p<0,00 42,05±8,7 42058 (42,05±8, 52999 52,99±9,5 0,48) 0080 (0,08–0, 2,39±0, 2390 (2,39±0 1740 1,74±0 41,9±10, 4191 (41,9±10 50,6±9 506 p00 p=0,0 [ ( –18 48,22±10, 48221 (48,22±10 58,52±10, 58521 0,08–0 (0,08–0,48 0,06–0 006 (0,06–0 p<0,0 42,05±8, 4205 (42,05±8 5299 52,99±9, 008 (0,08–0 2,39±0 239 (2,39± 174 1,74± 41,9±10 419 (41,9±1 50,6± p0 p=0, –1 48,22±10 4822 (48,22±1 58,52±10 5852 0,08– (0,08–0,4 0,06– (0,06– p<0, 42,05±8 420 (42,05± 529 52,99±9 (0,08– 2,39± (2,39 1,74 41,9±1 (41,9± 50,6 p=0 48,22±1 482 (48,22± 58,52±1 585 0,08 0,06 (0,06 p<0 42,05± (42,05 52,99± (0,08 2,39 (2,3 1,7 41,9± (41,9 50, p= 48,22± (48,22 58,52± (0,0 p< 42,05 (42,0 52,99 2,3 (2, 41,9 (41, 48,22 (48,2 58,52 42,0 (42, 52,9 2, (2 41, (41 48,2 (48, 58,5 42, (42 52, (4 48, (48 58,