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A comprehensive characterization of myocardial and vascular phenotype in pediatric chronic kidney disease using cardiovascular magnetic resonance imaging

BACKGROUND: Children with chronic kidney disease (CKD) have increased cardiovascular mortality. Identifying high-risk children who may benefit from further therapeutic intervention is difficult as cardiovascular abnormalities are subtle. Although transthoracic echocardiography may be used to detect...

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Autores principales: Cheang, Mun Hong, Barber, Nathaniel J., Khushnood, Abbas, Hauser, Jakob A., Kowalik, Gregorz T., Steeden, Jennifer A., Quail, Michael A., Tullus, Kjell, Hothi, Daljit, Muthurangu, Vivek
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5880006/
https://www.ncbi.nlm.nih.gov/pubmed/29609642
http://dx.doi.org/10.1186/s12968-018-0444-0
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author Cheang, Mun Hong
Barber, Nathaniel J.
Khushnood, Abbas
Hauser, Jakob A.
Kowalik, Gregorz T.
Steeden, Jennifer A.
Quail, Michael A.
Tullus, Kjell
Hothi, Daljit
Muthurangu, Vivek
author_facet Cheang, Mun Hong
Barber, Nathaniel J.
Khushnood, Abbas
Hauser, Jakob A.
Kowalik, Gregorz T.
Steeden, Jennifer A.
Quail, Michael A.
Tullus, Kjell
Hothi, Daljit
Muthurangu, Vivek
author_sort Cheang, Mun Hong
collection PubMed
description BACKGROUND: Children with chronic kidney disease (CKD) have increased cardiovascular mortality. Identifying high-risk children who may benefit from further therapeutic intervention is difficult as cardiovascular abnormalities are subtle. Although transthoracic echocardiography may be used to detect sub-clinical abnormalities, it has well-known problems with reproducibility that limit its ability to accurately detect these changes. Cardiovascular magnetic resonance (CMR) is the reference standard method for assessing blood flow, cardiac structure and function. Furthermore, recent innovations enable the assessment of radial and longitudinal myocardial velocity, such that detection of sub-clinical changes is now possible. Thus, CMR may be ideal for cardiovascular assessment in pediatric CKD. This study aims to comprehensively assess cardiovascular function in pediatric CKD using CMR and determine its relationship with CKD severity. METHODS: A total of 120 children (40 mild, 40 moderate, 20 severe pre-dialysis CKD subjects and 20 healthy controls) underwent CMR with non-invasive blood pressure (BP) measurements. Cardiovascular parameters measured included systemic vascular resistance (SVR), total arterial compliance (TAC), left ventricular (LV) structure, ejection fraction (EF), cardiac timings, radial and longitudinal systolic and diastolic myocardial velocities. Between group comparisons and regression modelling were used to identify abnormalities in CKD and determine the effects of renal severity on myocardial function. RESULTS: The elevation in mean BP in CKD was accompanied by significantly increased afterload (SVR), without evidence of arterial stiffness (TAC) or increased fluid overload. Left ventricular volumes and global function were not abnormal in CKD. However, there was evidence of LV remodelling, prolongation of isovolumic relaxation time and reduced systolic and diastolic myocardial velocities. CONCLUSION: Abnormal cardiovascular function is evident in pre-dialysis pediatric CKD. Novel CMR biomarkers may be useful for the detection of subtle abnormalities in this population. Further studies are needed to determine to prognostic value of these biomarkers. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12968-018-0444-0) contains supplementary material, which is available to authorized users.
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spelling pubmed-58800062018-04-04 A comprehensive characterization of myocardial and vascular phenotype in pediatric chronic kidney disease using cardiovascular magnetic resonance imaging Cheang, Mun Hong Barber, Nathaniel J. Khushnood, Abbas Hauser, Jakob A. Kowalik, Gregorz T. Steeden, Jennifer A. Quail, Michael A. Tullus, Kjell Hothi, Daljit Muthurangu, Vivek J Cardiovasc Magn Reson Research BACKGROUND: Children with chronic kidney disease (CKD) have increased cardiovascular mortality. Identifying high-risk children who may benefit from further therapeutic intervention is difficult as cardiovascular abnormalities are subtle. Although transthoracic echocardiography may be used to detect sub-clinical abnormalities, it has well-known problems with reproducibility that limit its ability to accurately detect these changes. Cardiovascular magnetic resonance (CMR) is the reference standard method for assessing blood flow, cardiac structure and function. Furthermore, recent innovations enable the assessment of radial and longitudinal myocardial velocity, such that detection of sub-clinical changes is now possible. Thus, CMR may be ideal for cardiovascular assessment in pediatric CKD. This study aims to comprehensively assess cardiovascular function in pediatric CKD using CMR and determine its relationship with CKD severity. METHODS: A total of 120 children (40 mild, 40 moderate, 20 severe pre-dialysis CKD subjects and 20 healthy controls) underwent CMR with non-invasive blood pressure (BP) measurements. Cardiovascular parameters measured included systemic vascular resistance (SVR), total arterial compliance (TAC), left ventricular (LV) structure, ejection fraction (EF), cardiac timings, radial and longitudinal systolic and diastolic myocardial velocities. Between group comparisons and regression modelling were used to identify abnormalities in CKD and determine the effects of renal severity on myocardial function. RESULTS: The elevation in mean BP in CKD was accompanied by significantly increased afterload (SVR), without evidence of arterial stiffness (TAC) or increased fluid overload. Left ventricular volumes and global function were not abnormal in CKD. However, there was evidence of LV remodelling, prolongation of isovolumic relaxation time and reduced systolic and diastolic myocardial velocities. CONCLUSION: Abnormal cardiovascular function is evident in pre-dialysis pediatric CKD. Novel CMR biomarkers may be useful for the detection of subtle abnormalities in this population. Further studies are needed to determine to prognostic value of these biomarkers. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12968-018-0444-0) contains supplementary material, which is available to authorized users. BioMed Central 2018-03-29 /pmc/articles/PMC5880006/ /pubmed/29609642 http://dx.doi.org/10.1186/s12968-018-0444-0 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Cheang, Mun Hong
Barber, Nathaniel J.
Khushnood, Abbas
Hauser, Jakob A.
Kowalik, Gregorz T.
Steeden, Jennifer A.
Quail, Michael A.
Tullus, Kjell
Hothi, Daljit
Muthurangu, Vivek
A comprehensive characterization of myocardial and vascular phenotype in pediatric chronic kidney disease using cardiovascular magnetic resonance imaging
title A comprehensive characterization of myocardial and vascular phenotype in pediatric chronic kidney disease using cardiovascular magnetic resonance imaging
title_full A comprehensive characterization of myocardial and vascular phenotype in pediatric chronic kidney disease using cardiovascular magnetic resonance imaging
title_fullStr A comprehensive characterization of myocardial and vascular phenotype in pediatric chronic kidney disease using cardiovascular magnetic resonance imaging
title_full_unstemmed A comprehensive characterization of myocardial and vascular phenotype in pediatric chronic kidney disease using cardiovascular magnetic resonance imaging
title_short A comprehensive characterization of myocardial and vascular phenotype in pediatric chronic kidney disease using cardiovascular magnetic resonance imaging
title_sort comprehensive characterization of myocardial and vascular phenotype in pediatric chronic kidney disease using cardiovascular magnetic resonance imaging
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5880006/
https://www.ncbi.nlm.nih.gov/pubmed/29609642
http://dx.doi.org/10.1186/s12968-018-0444-0
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