BACKGROUND Although acute effects of hemodialysis (HD) on cardiac functions in end-stage renal disease (ESRD) have been studied frequently in adults, limited data are available in pediatric age. Therefore, this work elucidates the acute impact of HD on cardiac functions using conventional echocardiography and two-dimensional (2D) speckle tracking in ESRD pediatric patients. METHODS Between June 2018 and April 2019, 40 ESRD pediatric subjects on chronic HD were prospectively recruited. All patients were subjected to history taking and baseline laboratory tests. Anthropometric measures, heart rate, blood pressure, and bioimpedance were assessed before and after HD session. Moreover, conventional echocardiography including M.mode and Doppler parameters for valves, as well as left ventricle (LV) 2D speckle tracking were performed pre- and post-dialysis session. RESULTS The included patients mean age was 12.9 ± 2.9 years, and males were 24 (60%). Significant reductions in body weight and blood pressure were noted after sessions. Post-dialysis LV and left atrial diameters, as well as left atrium to aortic diameter ratio, were lower. Nevertheless, conventional echocardiography-derived LV ejection fraction (EF), and fractional shortening were not significantly changed. Doppler-derived E/A ratio of mitral and tricuspid valves were lower post-dialysis. Global longitudinal strain (GLS) for LV was significantly reduced after dialysis (- 20.31 ± 3.58%, - 17.17 ± 3.40% vs, P < 0.0001), and global circumferential strain (GCS) was lower post-dialysis in comparison to pre-dialysis (- 21.37 ± 6.46% vs - 17.74 ± 6.16%, P < 0.0001). The speckle tracking-derived EF was significantly lower post-dialysis (57.58 ± 6.94 vs 53.64 ± 10.72, P = 0.018). All myocardial segments longitudinal and circumferential strains decreased significantly after dialysis. CONCLUSIONS Post-hemodialysis significant decline in left ventricular EF as well as global and segmental strains can be detected in ESRD pediatric patients using 2D speckle tracking, despite the nonsignificant changes in systolic functions derived from conventional echocardiography. This is considered additional evidence of HD deleterious effect on myocardial functions, particularly in the pediatric age.

中文翻译：

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小儿终末期肾脏疾病患者血液透析后心脏功能的变化：常规超声心动图和二维斑点追踪研究。

背景技术尽管已经在成年人中频繁研究了血液透析（HD）对终末期肾脏疾病（ESRD）心脏功能的急性影响，但在儿科年龄中可获得的数据有限。因此，这项工作阐明了在ESRD小儿患者中使用常规超声心动图和二维（2D）斑点追踪技术，HD对心脏功能的严重影响。方法在2018年6月至2019年4月期间，前瞻性招募了40名患有慢性HD的ESRD儿科受试者。所有患者均接受了病史和基线实验室检查。在HD会议之前和之后评估人体测量学指标，心率，血压和生物阻抗。此外，常规超声心动图包括瓣膜的M.mode和多普勒参数，在透析前和透析后进行左心室（LV）二维斑点跟踪。结果纳入的患者平均年龄为12.9±2.9岁，男性为2​​4岁（60％）。疗程结束后，体重和血压明显降低。透析后的LV和左心房直径以及左心房与主动脉直径之比较低。然而，传统的超声心动图衍生的左室射血分数（EF）和缩短的分数并没有明显改变。二尖瓣和三尖瓣的多普勒衍生E / A比在透析后较低。透析后左室总纵应变（GLS）显着降低（-20.31±3.58％，-17.17±3.40％vs，P <0.0001），透析后总周向应变（GCS）低于透析前（-21.37±6.46％与-17.74±6.16％，P <0.0001）。散斑跟踪衍生的EF透析后明显降低（57.58±6.94对53.64±10.72，P = 0.018）。透析后所有心肌节段的纵向和圆周应变均明显降低。结论血液透析后，尽管使用常规超声心动图检查的收缩功能无显着变化，但使用2D散斑追踪技术可在ESRD小儿患者中检测到左室EF以及整体和节段应变的显着下降。这被认为是HD对心肌功能有害作用的额外证据，尤其是在小儿时代。透析后所有心肌节段的纵向和圆周应变均明显降低。结论血液透析后，尽管使用常规超声心动图检查的收缩功能无显着变化，但使用2D散斑追踪技术可在ESRD小儿患者中检测到左室EF以及整体和节段应变的显着下降。这被认为是HD对心肌功能有害作用的额外证据，尤其是在小儿时代。透析后所有心肌节段的纵向和圆周应变均明显降低。结论血液透析后，尽管使用常规超声心动图检查的收缩功能无显着变化，但使用2D散斑追踪技术可在ESRD小儿患者中检测到左室EF以及整体和节段应变的显着下降。这被认为是HD对心肌功能有害作用的额外证据，尤其是在小儿时代。