Reduced systolic myocardial function in children with chronic renal insufficiency

Marcello Chinali, Giovanni De Simone, Maria Chiara Matteucci, Stefano Picca, Antonio Mastrostefano, Ali Anarat, Salim Çaliskan, Nikola Jeck, Thomas J. Neuhaus, Amira Peco-Antic, Licia Peruzzi, Sara Testa, Otto Mehls, Elke Wühl, Franz Schaefer

Research output: Contribution to journalArticlepeer-review


Increased left ventricular (LV) mass in children with chronic renal insufficiency (CRI) might be adaptive to sustain myocardial performance in the presence of increased loading conditions. It was hypothesized that in children with CRI, LV systolic function is impaired despite increased LV mass (LVM). Standard echocardiograms were obtained in 130 predialysis children who were aged 3 to 18 yr (59% boys) and had stages II through IV chronic kidney disease and in 130 healthy children of similar age, gender distribution, and body build. Systolic function was assessed by measurement of fractional shortening at the endocardial (eS) and midwall (mS) levels and computation of end-systolic stress (myocardial afterload). The patients with CRI exhibited a 6% lower eS (33.1 ± 5.5 versus 35.3 ± 6.1%; P <0.05) and 10% lower mS (17.8 ± 3.1 versus 19.7 ± 2.7%; P <0.001) than control subjects in the presence of significantly elevated BP, increased LVM, and more concentric LV geometry. Whereas the decreased eS was explained entirely by augmented end-systolic stress, mS remained reduced after correction for myocardial afterload. The prevalence of subclinical systolic dysfunction as defined by impaired mS was more than five-fold higher in patients with CRI compared with control subjects (24.6 versus 4.5%; P <0.001). Systolic dysfunction was most common (48%) in patients with concentric hypertrophy and associated with lower hemoglobin levels. CRI in children is associated with impaired intrinsic LV contractility, which parallels increased LVM.

Original languageEnglish
Pages (from-to)593-598
Number of pages6
JournalJournal of the American Society of Nephrology
Issue number2
Publication statusPublished - Feb 2007

ASJC Scopus subject areas

  • Nephrology


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