الفهرس 
Evaluation of cardiac function by tissue doppler in hypertensive children with renal diseases
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Abstract
Background: Children with chronic kidney disease have a high risk of morbidity and mortality. Cardiovascular disease is the main cause of death in patients with end-stage renal disease. It can start early and progress as renal disease progress. Aim of work: To determine the effect of different degrees of renal function status alteration associated with hypertension on cardiac function using tissue Doppler imaging in pediatric age group including renal transplantation patients. Methods: We conducted prospective cross-sectional study for 80 hypertensive children with different degrees of renal impairment. All of them were on regular follow up at the Pediatric Nephrology Unit or its outpatient clinics in Cairo University Children{u2019}s Hospital. All patients were subjected to history taking, clinical examination including anthropometric measurements, blood pressure measurements with both casual and ambulatory blood pressure monitoring (ABPM), laboratory work up and cardiac function assessment. We used tissue Doppler images and conventional pulsed wave Doppler to assess the diastolic function. Speckled tracing and M-mode were used to assess the systolic function. Results: Our study included 80 patients; 30 children with CKD grade 1-4, 30 children on regular hemodialysis and 20 transplant recipients. 48 children (60%) had systolic dysfunction by global longitudinal strain (GLS) using speckle tracking echocardiography (STE), while conventional echocardiography detected systolic dysfunction in only 3 (3.75%) patients by using EF%. 46 children (57.5%) had diastolic dysfunction by LV E/E` ratio using Tissue Doppler imaging (TDI). While conventional pulsed wave Doppler did not detect any diastolic dysfunction by using mitral E/A ratio. Left ventricular hypertrophy (LVH) was strongly correlated with systolic and diastolic dysfunction. We did not find any significant relation between uncontrolled hypertension (HTN) and cardiac dysfunction. Patients who suffer from anemia, low GFR or albuminuria are at a higher risk for development of cardiac affection. Conclusion: Hypertensive patients with underlying renal disease are at high risk for cardiac affection. Tissue Doppler imaging and speckled tracing are more sensitive methods for assessment of cardiac function than conventional echocardiography pulsed wave Doppler. LVH could be used as a predictor for cardiac affection. Cardiac function evaluation is a must in patients with different degrees of renal impairments even in early stages of CKD