Left Ventricular Strain and Left Atrial Strain Are Impaired During Hemodialysis in Children

Abstract Background Cardiac mortality and morbidity remain significant in children on chronic hemodialysis (HD). Multiple markers by speckle tracking echocardiography (STE) are predictive of cardiac events in adults, but data in children are limited; ventricular diastolic strain (Ds) and left atrial strain (LAS) have not been reported. The aim of this study was to investigate intradialytic changes in ventricular and atrial function using STE in children. Methods Secondary analysis of a prospective descriptive study of children with structurally normal hearts and HD vintage > 3 months, using echocardiography performed prior to, during, and after HD. STE was analyzed using GE EchoPAC. Left ventricular (LV) global longitudinal strain (GLS), strain rate (Sr), and mechanical dispersion index (MDI) were calculated as the average from 3 apical views; Ds and Sr were obtained from 4-chamber tracing; LAS and Sr were assessed during atrial contraction, reservoir, and conduit. Intradialytic changes in 2D STE markers of ventricular function and LAS and their association with blood volume (BV) removal and blood pressure (BP) change were studied. Results A total of 15 children were enrolled at a median age of 12 years (IQR 8, 16) and median HD vintage of 13 months (IQR 9, 25). GLS was impaired during HD (-15.8 ± 2.2% vs -19.9 ± 1.9%, p < 0.001). Post-HD GLS was associated mean BP decrease (coefficient = 0.62, p = 0.01) and not with BV removal (coefficient = 0.49, p = 0.06). LV MDI and systolic Sr did not change. LV Ds was progressively impaired (-8.4% (-9.2, -8.0) vs − 11.9% (-13.4, -10.3), p < 0.001). LAS conduit and reservoir worsened at mid-HD and returned to baseline post-HD. Changes in Ds, DSr, LAS, LASr were not associated with BV removal or BP decrease (p > 0.1). Conclusions Intradialytic LV strain and LAS impairment consistent with subclinical systolic and diastolic dysfunction were observed during HD in children. GLS impairment was associated with BP change, but changes in Ds, DSr, LAS, and LASr were not associated with BP change or BV removal. Longitudinal assessment using these novel non-invasive indices may unfold the effect of cumulative subclinical changes on long-term outcomes in children who are on chronic HD.