ASSESSMENT OF LEFT VENTRICULAR MYOCARDIAL DYSFUNCTION IN CHILDREN WITH END-STAGE KIDNEY DISEASE USING TWO-DIMENSIONAL AND THREE-DIMENSIONAL SPECKLE-TRACKING ECHOCARDIOGRAPHY

Objective: We assessed left ventricular (LV) myocardial dysfunction in children with end-stage chronic kidney disease (CKD) using two-dimensional (2D) and three-dimensional (3D) speckle-tracking echocardiography (STE) for early detection of subclinical systolic impairment. Methods: This prospective observational study included 20 children with end-stage CKD receiving maintenance hemodialysis for at least 12 months were enrolled. All participants completed the study. Inclusion criteria were age <18 years and regular hemodialysis for ≥1 year. Patients with known congenital or acquired structural heart disease were excluded. LV ejection fraction (EF) measured by 2D and 3D echocardiography; 2D global longitudinal strain (GLS); and 3D global peak systolic longitudinal strain (GPSL) Results: The mean 2D EF was 59 ± 7.2%, whereas 3D EF was significantly lower 43.8 ± 14.8%; (P = 0.001). Mean 2D GLS and 3D GPSL were −14.3 ± 2.4% and −13.7 ± 2.7%, respectively, both substantially less negative than normal pediatric values, indicating subclinical systolic dysfunction. Conclusion: Children with CKD on maintenance hemodialysis exhibit early LV systolic dysfunction detectable by 2D and 3D STE despite preserved EF on conventional echocardiography. Speckle-tracking imaging provides a sensitive, noninvasive method for early detection of uremic cardiomyopathy and should be integrated into routine cardiac assessment in pediatric CKD.