Assessment of Left and Right Atrial Functions in Children on Regular Hemodialysis: A Speckle Tracking Imaging Study

Background: For children with chronic renal disease, cardiovascular disease is the predominant cause of morbidity and mortality. Clinically evident illness is often preceded by early, mild cardiac dysfunction. Two-dimensional speckle tracking echocardiography (2D-STE), which measures left and right atrial mechanics, provides sensitive indicators of subclinical cardiac damage. Aim: This study aimed to employ 2D speckle tracking imaging to evaluate the left and right atrial functions of pediatric chronic kidney disease (CKD) patients receiving regular hemodialysis. Patients and methods: 22 children with end-stage renal disease (ESRD) receiving regular hemodialysis and 22 age- and sex-matched healthy controls participated in this case-control study. All participants received clinical evaluation, 2D-STE, tissue Doppler imaging and conventional echocardiography. LA and RA reservoir, conduit and contractile strain characteristics were measured. The relationship between atrial strain, ventricular wall thickness and dialysis duration was also examined. Results: Hemodialysis patients had significantly lower weight, height, and BSA compared with controls (p<0.001). Conventional echocardiography showed increased interventricular septal and posterior wall thickness with normal LV systolic function. LA strain was significantly impaired in all phases in both 4- and 2-chamber views (p<0.001), with the 2-chamber view more sensitive. RA strain was reduced, especially in reservoir and contractile phases (p<0.001). Duration of dialysis and ventricular hypertrophy were negatively correlated with LA reservoir and conduit strain (p<0.05), suggesting progressive atrial dysfunction. Conclusion: 2D Speckle tracking echocardiography is a very sensitive & noninvasive tool for early detection of subtle cardiac diastolic impairment in pediatric CKD patients on dialysis by detecting significant reduction in LA & RA strain values.