Left Ventricular Hypertrophy and Cardiac Troponin I in Pediatric Hemodialysis

Journal of Clinical and Basic Cardiology 2009; 12 (1-4): 5-10

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Keywords: Hämodialyse,  Kardiales Troponin I,  Kardiologie,  cardiac troponin I,  hemodialysis,  left ventricular hypertrophy

Left ventricular hypertrophy (LVH) is associated with cardiovascular morbidity and mortality in hemodialysis patients. Cardiac troponins (cTn) were proposed as markers of cardiac damage, but their value is still debated in hemodialysis patients. Objective: To assess LVH and cTnI in Egyptian pediatric patients on regular hemodialysis and their relationship to dialysis-related hypotension episodes and mortality over a period of one year. Patients and Methods: This study included 30 children on regular hemodialysis. Patients were subjected to 2-D, M-mode Doppler echocardiography with calculation of the left ventricular mass index (LVMI). Serum cTnI was assessed using an immunoassay test. Patients were clinically followed up for one year. Results: LVH (as measured by LVMI) was detected in 66.7 % of patients. Concentric hypertrophy was present in 43.3 % and eccentric hypertrophy in 23.3 % of patients. Although serum cTnI was < 1 ng/ml hypotension episodes occurred in 13.3 % of patients and mortality occurred in 10 % of them. The positive predictive value of LVMI to mortality was 28.6 %; negative predictive value was 95.7 % with 81.5 % specificity and 66.7 % sensitivity. Low fractional shortening (FS) was an excellent predictor of mortality with a positive predictive value of 100 %; the negative predictive value was 96.4 % with 100 % specificity and 66.7 % sensitivity. Conclusion: Hemodialysis pediatric patients had cardiovascular risk factors since LVH was highly prevalent in them. Low FS and increased LVMI remain relatively good predictors of mortality in those patients. Normal cTnI does not preclude cardiovascular risk in hemodialysis pediatric patients and is not a predictor for short-term prognosis (1-year follow-up).