Left ventricular dysfunction by conventional and tissue Doppler echocardiography in pediatric hemodialysis patients: relation with plasma brain natriuretic peptide levels.

Introduction: Tissue Doppler imaging (TDI) is a relatively new echocardiography method in children with chronic kidney disease (CKD). The aims of this study were to evaluate left ventricular (LV) diastolic function in pediatric CKD patients using conventional pulsed-wave Doppler echocardiography (cPWD) and TDI methods and correlate them with BNP levels.

Material And Methods: Thirty children on regular hemodialysis (HD) were included. Left ventricular systolic and diastolic indices and BNP levels were measured immediately before and after HD.

Results: After HD, LV and left atrium diameters were significantly decreased ( < 0.001 and < 0.001, respectively). Transmitral E velocity and E/A ratio decreased ( < 0.001 and < 0.001, respectively). Also, there were significant decreases in the early diastolic velocity E' of LV wall, septal wall, and anterior wall ( = 0.001, = 0.004 and < 0.001, respectively). Mean E/E' ratio and ratios of septal and lateral walls were decreased significantly ( = 0.004, = 0.002 and = 0.017, respectively). BNP levels decreased significantly during HD when comparing concentrations before and after HD ( < 0.001). BNP strongly correlated with LV diastolic function indices (before HD: mean E/E' ( = 0.401, = 0.028), lateral E/E" ( = 0.291, = 0.025), septal E'( = -0.398, = 0.029), lateral wall E' ( = -0.452, = 0.012) and mean E' ( = -0.469, = 0.009), after HD: mean E/E' ( = 0.38, = 0.038) and lateral E/E" ( = 0.474, = 0.008) and lateral wall E' ( = -0.270, = 0.037)).

Conclusions: The cPWD and TDI-derived LV indices are influenced by HD. The diagnostic utility of BNP in the presence of deteriorating renal function may be compromised to some extent.