LAUSR

Objectives: To examine the consequences of elevated myocardial wall stress (MWS) in children with and without chronic kidney disease (CKD). Methods: 100 children (10.6 ± 3.0 years) including 66 children with CKD were studied for two visits (average of 24.4 ± 11.0 months), of those 55 (38 CKD) had third visit (average of 21.5 ± 11.5 months). Echocardiography and carotid tonometry were performed at each visit. LV cavity and epicardial volumes were obtained from wall tracking analysis. Carotid pressure during systole was used to estimate LV pressure. MWS was calculated from LV volumes and pressure. Results: Characteristics of children with and without CKD were similar but peak and mean MWS were greater in children with CKD than in controls at visit one. Between visit one and visit two, children with highest MWS exhibited less increase in LV length: 0.15 ± 0.29 vs. 1.81 + 0.28 cm, for upper compared to lower tertiles of mean MWS (p < 0.001) and less increase in end-diastolic volume (EDV): 2.5 ± 2.6 vs. 20.0 ± 3.1mls (p < 0.001), but changes in left ventricular mass (LVM) were similar in the two groups (Figure 1a and 1b). Between visit two and visit three, children with highest MWS at visit two, exhibited significant increase in LVM: 12.8 ± 3.4vs-1.47 ± 3.7 g (p = 0.024), whereas change in EDV was not differ in two groups (Figure 1c and 1d). In multiple regression analysis, mean MWS was negatively associated with change in EDV during the first follow up period, whereas it was positively associated with change in LVM during the seconding follow up period (table 1). Conclusion: Increased MWS is associated with an impairment of longitudinal ventricular growth in younger children and increased LVM in older children which lead to concentric hypertrophy that may contribute to the high risk of cardiac events in children with CKD.