Datasheet1_Get to the heart of pediatric kidney transplant recipients: Evaluation of left- and right ventricular mechanics by three-dimensional echocardiography.docx

BackgroundKidney transplantation (KTX) markedly improves prognosis in pediatric patients with end-stage kidney failure. Still, these patients have an increased risk of developing cardiovascular disease due to multiple risk factors. Three-dimensional (3D) echocardiography allows detailed assessment of the heart and may unveil distinct functional and morphological changes in this patient population that would be undetectable by conventional methods. Accordingly, our aim was to examine left- (LV) and right ventricular (RV) morphology and mechanics in pediatric KTX patients using 3D echocardiography.
Materials and methodsPediatric KTX recipients (n = 74) with median age 20 (14–26) years at study enrollment (43% female), were compared to 74 age and gender-matched controls. Detailed patient history was obtained. After conventional echocardiographic protocol, 3D loops were acquired and measured using commercially available software and the ReVISION Method. We measured LV and RV end-diastolic volumes indexed to body surface area (EDVi), ejection fraction (EF), and 3D LV and RV global longitudinal (GLS) and circumferential strains (GCS).
ResultsBoth LVEDVi (67 ± 17 vs. 61 ± 9 ml/m2; p < 0.01) and RVEDVi (68 ± 18 vs. 61 ± 11 ml/m2; p < 0.01) were significantly higher in KTX patients. LVEF was comparable between the two groups (60 ± 6 vs. 61 ± 4%; p = NS), however, LVGLS was significantly lower (−20.5 ± 3.0 vs. −22.0 ± 1.7%; p < 0.001), while LVGCS did not differ (−29.7 ± 4.3 vs. −28.6 ± 10.0%; p = NS). RVEF (59 ± 6 vs. 61 ± 4%; p < 0.05) and RVGLS (−22.8 ± 3.7 vs. −24.1 ± 3.3%; p < 0.05) were significantly lower, however, RVGCS was comparable between the two groups (−23.7 ± 4.5 vs. −24.8 ± 4.4%; p = NS). In patients requiring dialysis prior to KTX (n = 64, 86%) RVGCS showed correlation with the length of dialysis (r = 0.32, p < 0.05).
ConclusionPediatric KTX patients demonstrate changes in both LV and RV morphology and mechanics. Moreover, the length of dialysis correlated with the contraction pattern of the right ventricle.

背景：肾移植（Kidney Transplantation, KTX）可显著改善终末期肾衰竭儿科患者的预后。然而，受多重危险因素影响，此类患者罹患心血管疾病的风险仍有所升高。三维（3D）超声心动图（three-dimensional (3D) echocardiography）可对心脏进行细致评估，能够发现该人群中常规检查无法检出的特异性功能与形态学改变。因此本研究旨在采用三维超声心动图，探究肾移植儿科患者的左心室（Left Ventricular, LV）与右心室（Right Ventricular, RV）形态及力学特征。
材料与方法：本研究纳入74名肾移植儿科受者，入组时中位年龄为20（14~26）岁，其中女性占比43%；以74名年龄、性别相匹配的健康个体作为对照。研究收集了受试者详细的病史资料。在完成常规超声心动图检查后，采用商用软件及ReVISION方法获取并分析三维心动周期图像。我们测量了以体表面积校正的左心室舒张末期容积指数（end-diastolic volume indexed, EDVi）、射血分数（ejection fraction, EF），以及左、右心室的三维整体纵向应变（global longitudinal strain, GLS）与整体圆周应变（global circumferential strain, GCS）。
结果：肾移植患者的左心室舒张末期容积指数（LVEDVi，67±17 vs. 61±9 ml/m²；p<0.01）与右心室舒张末期容积指数（RVEDVi，68±18 vs. 61±11 ml/m²；p<0.01）均显著高于对照组。两组的左心室射血分数（LVEF）无显著差异（60±6 vs. 61±4%；p=无统计学意义），但左心室整体纵向应变（LVGLS）显著降低（-20.5±3.0 vs. -22.0±1.7%；p<0.001），而左心室整体圆周应变（LVGCS）无组间差异（-29.7±4.3 vs. -28.6±10.0%；p=无统计学意义）。右心室射血分数（RVEF，59±6 vs. 61±4%；p<0.05）与右心室整体纵向应变（RVGLS，-22.8±3.7 vs. -24.1±3.3%；p<0.05）均显著低于对照组，而右心室整体圆周应变（RVGCS）无组间差异（-23.7±4.5 vs. -24.8±4.4%；p=无统计学意义）。在术前需接受透析的肾移植患者（n=64，占比86%）中，右心室整体圆周应变（RVGCS）与透析时长呈显著相关（r=0.32，p<0.05）。
结论：儿科肾移植患者的左、右心室均存在形态与力学特征改变。此外，术前透析时长与右心室收缩模式存在相关性。