Left Ventricular Hypertrophy and Cardiac Troponin I in Pediatric Hemodialysis

[摘要] Left ventricular hypertrophy (LVH) is associated with cardiovascular morbidity and mortality in hemodialysis patients. Cardiac troponins (cTn)were proposed as markers of cardiac damage, but their value is still debated in hemodialysis patients. Objective: To assess LVH and cTnI inEgyptian pediatric patients on regular hemodialysis and their relationship to dialysis-related hypotension episodes and mortality over a period ofone year. Patients and Methods: This study included 30 children on regular hemodialysis. Patients were subjected to 2-D, M-mode Dopplerechocardiography with calculation of the left ventricular mass index (LVMI). Serum cTnI was assessed using an immunoassay test. Patients wereclinically followed up for one year. Results: LVH (as measured by LVMI) was detected in 66.7 % of patients. Concentric hypertrophy was presentin 43.3 % and eccentric hypertrophy in 23.3 % of patients. Although serum cTnI was < 1 ng/ml hypotension episodes occurred in 13.3 % ofpatients and mortality occurred in 10 % of them. The positive predictive value of LVMI to mortality was 28.6 %; negative predictive value was95.7 % with 81.5 % specificity and 66.7 % sensitivity. Low fractional shortening (FS) was an excellent predictor of mortality with a positivepredictive value of 100 %; the negative predictive value was 96.4 % with 100 % specificity and 66.7 % sensitivity. Conclusion: Hemodialysispediatric patients had cardiovascular risk factors since LVH was highly prevalent in them. Low FS and increased LVMI remain relatively goodpredictors of mortality in those patients. Normal cTnI does not preclude cardiovascular risk in hemodialysis pediatric patients and is not a predictorfor short-term prognosis (1-year follow-up).

[学科分类] 心脏病和心血管学

[关键词] Hämodialyse;Kardiales Troponin I;Kardiologie;cardiac troponin I;hemodialysis;left ventricular hypertrophy