Assessment of Right Ventricular Myocardial Dysfunction in Children on Hemodialysis.

Abdelsalam, Manal; Abdelrahman, Tagreed; Ahmad, Ghada Mohamed. S.; Goda, Rasha M; Riad, Nadia Youssef; Said, Taher

doi:10.21608/geget.2022.287553

Assessment of Right Ventricular Myocardial Dysfunction in Children on Hemodialysis.

Document Type : Original Article

Authors

¹ Department of Pediatrics, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt.

² Department of Cardiology, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt.

³ Department of Clinical Pathology, National Heart Institute, Cairo, Egypt.

⁴ Islamic Center of Cardiology, Al-Azhar University, Cairo, Egypt.

10.21608/geget.2022.287553

Abstract

Introduction: Little attention has been paid to evaluating the right ventricle (RV), considered the forgotten side of the heart. Adenine DiMethyl Arginine (ADMA), growth differentiation factor15 (GDF-15), and highly sensitive (hs-CRP) may play a role in the development of RV dysfunction.
Aim of the Study: To reveal right ventricular (RV) function via conventional echocardiography and the new echocardiography (ECHO) modality to reveal the long‐term impacts of hemodialysis (HD)on the RV in children on HD patients and assess the relationship between RV dysfunction and (ADMA), (GDF-15) and hs-CRP.
Methods: (ADMA, GDF-15, and hs-CRP) were analyzed in forty pediatric patients on HD and their forty controls. Also, the right ventricle was assessed by conventional Echo Doppler modalities, tissue Doppler imaging (TDI), and global RV strain by speckled tracking ECHO in the same line with routine laboratory investigations.
Results Significantly higher levels of ADMA, GDF-15, and hs-CRP in HD children than controls. Reduced RV function was detected in 16 (40%) out of 40 children. Significantly lower RV ventricular functions – RV Ejection Fraction & RV Fractional area change (RVEF % and RVFAC) and higher TV A vel, and TV E A vel ratio were found in (HD) group than in controls. Significant decrease in TDI tricuspid annular velocities E´) with significantly decreased right ventricular strain detected by TDI as well as STE in hemodialysis children than in their controls.
Conclusion: RV dysfunction is not uncommon in HD children; 2D-FAC is a traditional ECHO parameter for detecting right ventricular dysfunction in HD children; moreover, STE-GLS of the RV is an easily feasible assessment method, especially in those patients. ADMA is highly sensitive in predicting RV dysfunction in HD children.

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