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Left ventricular mass and systolic function in children with chronic kidney disease—comparing echocardiography with cardiac magnetic resonance imaging

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Abstract

Background

Increased left ventricular mass (LVM) is an important risk marker of uremic cardiovascular disease. Calculation of LVM by echocardiography (Echo) relies on geometric assumptions and in adults on hemodialysis overestimates LVM compared to cardiac magnetic resonance (CMR). We compare both techniques in children with chronic kidney disease (CKD).

Methods

Concurrent Echo and CMR was performed in 25 children with CKD (14 after kidney transplantation) aged 8–17 years.

Results

Compared to normal children, CMR-LVM was increased (standard deviation score (SDS) 0.39 ± 0.8 (p = 0.03)), stroke volume and cardiac output decreased (SDS −1.76 ± 1.1, p = 0.002 and −1.11 ± 2.0, p = 0.001). CMR-LVM index but not Echo-LVMI correlated to future glomerular filtration rate (GFR) decline (r = −0.52, p = 0.01). Mean Echo-LVM was higher than CMR-LVM (117 ± 40 vs. 89 ± 29 g, p < 0.0001), with wide limits of agreement (−6.2 to 62.8 g). The Echo-CMR LVM difference increased with higher Echo-LVMI (r = 0.77, p < 0.0001). Agreement of classifying left ventricular hypertrophy was poor with Cohen’s kappa of 0.08. Mean Echo and CMR-ejection fraction differed by 1.42 % with wide limits of agreement (−12.6 to 15.4 %).

Conclusions

Echo overestimates LVM compared to CMR, especially at higher LVM. Despite this, CMR confirms increased LVM in children with CKD. Only CMR-LVMI but not Echo-LVMI correlated to future GFR decline.

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Acknowledgments

The authors would like to thank Adriana Komancsek (radiographer) for the competent acquisition of CMR images.

Ethical approval

The study confirmed to the declaration of Helsinki, was approved by the ethics committee of the University of Freiburg and registered in the German registry of clinical trials (Deutsches Register Klinische Studien, trial no. DRKS00003295).

Informed consent

Prior written informed consent was obtained from all parents (and adolescents where appropriate).

Conflict of interest

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Pediatric Cardiology, Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany

    Raoul Arnold

  2. Hospital for Children, Stadtspital Triemli, Zurich, Switzerland

    Daniel Schwendinger

  3. Division of Nuclear Medicine, University Hospital Freiburg, Freiburg, Germany

    Sabine Jung

  4. Department of Radiology, University Children’s Hospital Zurich, Zurich, Switzerland

    Julia Geiger

  5. Center for Pediatrics and Adolescent Medicine, University Hospital Freiburg, Freiburg, Germany

    Martin Pohl & Charlotte Gimpel

  6. Institute of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern, Switzerland

    Bernd Jung

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  1. Raoul Arnold
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  3. Sabine Jung
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Correspondence to Charlotte Gimpel.

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Supplementary table

Available pediatric normal values for left ventricular dimensions (DOCX 39 kb)

Glossary

BSA

Body surface area

CMR(−)

Cardiac magnetic resonance/measured by CMR

Echo(−)

Echocardiography/ echocardiographicaly measured

EF

Ejection fraction

LVM

Left ventricular mass

LVH

Left ventricular hypertrophy

LVMI

LVM indexed to height in m2.7

LVMBSA

LVM normalized to body surface area

ABPM

24-hour ambulatory blood pressure measurement

CKD

Chronic kidney disease

CI

Confidence interval

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Arnold, R., Schwendinger, D., Jung, S. et al. Left ventricular mass and systolic function in children with chronic kidney disease—comparing echocardiography with cardiac magnetic resonance imaging. Pediatr Nephrol 31, 255–265 (2016). https://doi.org/10.1007/s00467-015-3198-z

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  • DOI: https://doi.org/10.1007/s00467-015-3198-z

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