Introduction: Renal transplantation (RTx) improves prognosis in children with end-stage kidney disease; however, these patients are prone to cardiovascular damage due to multiple risk factors. As major CV events are rare in children early subclinical changes of the heart and vessels should be assessed by non- invasive methods. Our aim was to assess myocardial structure and function in pediatric RTx by conventional and speckle tracking echocardiography (STE).
Methods: Forty-two RTx and 39 healthy age- and gender-matched children were evaluated. RTx recipients were further categorized according to the control of hypertension assessed by 24-hour ambulatory blood pressure monitoring (ABPM). Subjects underwent pulse wave velocity (PWV) measurement, conventional echocardiography and 2-dimensional STE. Left- and right ventricular (LV, RV) global longitudinal strain (GLS) and LV circumferential strain (GCS) were measured.
Results: RTx patients had increased blood pressure and arterial stiffness. LV ejection fraction (EF) was preserved along with elevated LV mass index (LVMi), while LVGLS was significantly lower whereas LVGCS and RVGLS were increased in RTx. Uncontrolled hypertensives had lower LVGLS compared to those with controlled hypertension. Using multiple forward stepwise regression analysis, 24-hour SBP and relative wall thickness (RWT) were independent determinants of LVMi, whereas antihypertensive therapy and eGFR were independent determinants of LVGLS.
Conclusions: Cardiac morphology and function show distinct changes after RTx. Along with comparable ventricular volumes, LV concentric hypertrophy and subclinical myocardial dysfunction are present. Control of hypertension and renal graft function are major factors of LV performance. STE may be useful to reveal early myocardial dysfunction in pediatric RTx.