Diastolic Function Parameters in Different Stages of Children with Chronic Kidney Disease: A Subclinical Speckle Tracking Echocardiography Study
DOI:
https://doi.org/10.30701/ijc.2117Keywords:
Children chronic kidney disease, Diastolic function, Speckle tracking echocardiography, Left atrial strainAbstract
Background: Chronic Kidney Disease (CKD) in children was associated with an increased risk of long-term cardiovascular morbidity and mortality. Diastolic dysfunction, represented by an early cardiac manifestation of CKD, was often subclinical and might not be detected by conventional echocardiography. Speckle Tracking Echocardiography (STE), which assesses left atrial function, provided a potentially sensitive evaluation of early diastolic functional changes. This study aimed to compare stages of CKD in children with diastolic function parameters assessed by STE.
Methods: An analytic cross-sectional study conducted at RSUP M. Djamil Padang from September to December 2025, involving 44 children with CKD who were divided equally into two groups: Group I, early-stage CKD (stages 1–3) children, and Group II, advanced-stage CKD (stages 4–5) children. STE was performed to assess Left Atrial Reservoir Strain (LASr), Conduit Strain (LAScd), and Contractility Strain (LASct). Combination with echocardiography, conventional and STE by evaluating Left Atrial Stiffness Index (LASI) from E/e’ / LASr, and Left Atrial Filling Index (LAFI) from E transmitral velocity / LASr was performed in both groups. Statistical analyses included the Shapiro–Wilk normality test, followed by an independent t-test or Mann–Whitney test.
Results: In this study, no significant differences were found in age, sex, comorbidities, therapy, Left Ventricular Ejection Fraction (LVEF), and Left Atrium dimension between the two groups. The left atrial speckle tracking parameters in Groups I and II were as follows: LASr 44.89±2.22% vs 30.54±6.25% (p=0.000); LAScd ?33.50±3.66% vs. ?21.65±7.57% (p=0.000); LASct ?11.35% (?5.4 to ?17.8%) vs ?7.70% (?2.1 to ?21.0%) (p=0.018); LASI 0.15 (0.12–0.26) vs 0.32 (0.18–0.82) (p=0.000); and LAFI 1.99 (1.38–3.04) vs. 2.93 (2.19–6.65) (p=0.000).
Conclusions: Children with advanced-stage CKD demonstrated significantly reduced LASr, LAScd, and LASct and increased LASI and LAFI compared with those with early-stage CKD, indicating impaired diastolic function detected by left atrial STE.
Downloads
References
1. Bikbov B, Purcell C, Levey AS, et al. Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2020;395(10225):709-733. doi:10.1016/S0140-6736(20)30045-3
2. Sethna CB, Merchant K, Reyes A. Cardiovascular Disease Risk in Children With Kidney Disease. Semin Nephrol. 2018;38(3):298-313. doi:10.1016/j.semnephrol.2018.02.009
3. Robinson S, Ring L, Oxborough D, et al. The assessment of left ventricular diastolic function: guidance and recommendations from the British Society of Echocardiography. Echo Res Pract. 2024;11(1):1-55. doi:10.1186/s44156-024-00051-2
4. Cameli M, Lisi M, Focardi M, et al. Left atrial deformation analysis by speckle tracking echocardiography for prediction of cardiovascular outcomes. Am J Cardiol. 2012;110(2):264-269. doi:10.1016/j.amjcard.2012.03.022
5. Hope KD, Wang Y, Banerjee MM, Montero AE, Pandian NG, Banerjee A. Left atrial mechanics in children: insights from new applications of strain imaging. Int J Cardiovasc Imaging. 2019;35(1):57-65. doi:10.1007/s10554-018-1429-7
6. Braunauer K, Düngen HD, Belyavskiy E, et al. Potential usefulness and clinical relevance of a novel left atrial filling index to estimate left ventricular filling pressures in patients with preserved left ventricular ejection fraction. Eur Heart J Cardiovasc Imaging. 2020;21(3):260-269. doi:10.1093/ehjci/jez272
7. Atkinson MA, Ng DK, Warady BA, et al. The CKiD study: Overview and summary of findings related to kidney disease progression. HHS Public Access. 2021;36(3):527-538. doi:10.1007/s00467-019-04458-6
8. Ketteler M, Block GA, Evenepoel P, et al. Executive summary of the 2017 KDIGO Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) Guideline Update: what’s changed and why it matters. Kidney Int. 2017;92(1):26-36. doi:10.1016/j.kint.2017.04.006
9. Doyon A, Haas P, Erdem S, et al. Impaired Systolic and Diastolic Left Ventricular Function in Children with Chronic Kidney Disease - Results from the 4C Study. Sci Rep. 2019;9(1):1-9. doi:10.1038/s41598-019-46653-3
10. Penachio FM, de Fátima Rodrigues Diniz M, Laurino RSP, et al. Speckle-Tracking: Incremental Role in Diastolic Assessment of Pediatric Patients with Chronic Kidney Disease. Arq Bras Cardiol. 2024;121(3):1-12. doi:10.36660/abc.20230131
11. Singh S, Aggarwal V, Kumar U, Sreenidhi HC. Original article Study of left ventricular systolic dysfunction, left ventricular diastolic dysfunction and pulmonary hypertension in CKD 3b-5ND patients — A single centre cross-sectional study. 2022;3(5):596-605.
12. Mitsnefes MM, Xu Y, Ng DK, et al. Diastolic Function and Ambulatory Hypertension in Children With Chronic Kidney Disease. Hypertension. 2021;78(5):1347-1354. doi:10.1161/HYPERTENSIONAHA.121.17449
13. Inoue K, Khan FH, Remme EW, et al. Determinants of left atrial reservoir and pump strain and use of atrial strain for evaluation of left ventricular filling pressure. Eur Heart J Cardiovasc Imaging. 2022;23(1):61-70.
14. Schoenmaker NJ, Kuipers IM, Van Der Lee JH, et al. Diastolic dysfunction measured by tissue Doppler imaging in children with end-stage renal disease: a report of the RICH-Q study. Cardiology in the Young (2014), 24: 236–244
15. Cantinotti M, Giordano M, Scalese M, et al. Nomograms for mitral inflow Doppler and tissue Doppler velocities in Caucasian children. Journal of Cardiology 68 (2016): 288–299
16. Sun M, Xing Y, Guo Y, et al. Left atrial reservoir strain is an outstanding predictor of adverse cardiovascular outcomes in patients undergoing maintenance hemodialysis?: Assessment via three ? dimensional speckle tracking echocardiography. 2022;(September 2021):549-557. doi:10.1002/clc.23815
17. Cantinotti M, Capponi G, Marchese P, et al. Normal Values for Speckle-Tracking Echocardiography in Children: A Review, Update, and Guide for Clinical Use of Speckle-Tracking Echocardiography in Pediatric Patients. J. Clin. Med. 2025, 14: 1090. doi: 10.3390/jcm14041090
18. Zuckerberg JC, Matsubara D, Kauffman HL, et al. Left atrial stiffness and strain are novel indices of left ventricular diastolic function in children?: validation followed by application in multisystem inflammatory syndrome in children due to COVID-19. Eur Hear J - Cardiovasc Imaging. 2023;24(9):1241-1251. doi:10.1093/ehjci/jead087
19. Kim D, Seo JH, Choi KH. Prognostic implications of left atrial stiffness index in heart failure patients with preserved ejection fraction. JACC: Cardiovascular Imaging. 2023;16(4). doi:10.1016/j.jcmg.2022.11.002
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Indonesian Journal of Cardiology
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
