Left ventricular strain and left atrial strain are impaired during hemodialysis in children

Tam T. Doan, Poyyapakkam Srivaths, Asela Liu, J. Kevin Wilkes, Alexandra Idrovo, Ayse Akcan-Arikan, Sarah Swartz, Jessica Geer, Carolyn A. Altman, Nancy A. Ayres, Robert W. Loar, Ricardo Pignatelli

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


We aimed to investigate intradialytic changes in ventricular and atrial function using speckle tracking echocardiography (STE) in pediatric hemodialysis (HD). Children with HD vintage > 3 months were enrolled, and echocardiography was performed prior to, during, and after HD. STE was analyzed using GE EchoPAC. Left ventricular (LV) global longitudinal strain (GLS), strain rate (Sr), and mechanical dispersion index (MDI) were calculated as the average from 3 apical views; diastolic strain (Ds) and Sr from 4-chamber tracing; left atrial strain (LAS) and Sr from the 4- and 2-chamber views. A total of 15 patients were enrolled at a median age of 12 years (IQR 8, 16) and median HD vintage of 13 months (IQR 9, 25). GLS worsened during HD (− 15.8 ± 2.2% vs − 19.9 ± 1.9%, p < 0.001). Post-HD GLS was associated with BP decrease (coefficient = 0.62, p = 0.01). LV MDI and systolic Sr did not change. LV Ds progressively worsened (− 8.4% (− 9.2, − 8.0) vs − 11.9% (− 13.4, − 10.3), p < 0.001). LAS changes at mid-HD returned to baseline post-HD. Ds, DSr, LAS, LASr were not associated with BV removal or BP decrease (p > 0.1). In conclusions, intradialytic LV strain and LAS changes consistent with subclinical systolic and diastolic dysfunction were observed during HD in children. Changes in Ds, DSr, LAS, and LASr were not associated with BP change or BV removal and may be related to the disease progression. Longitudinal study using these novel indices may unfold the effect of these subclinical changes on long-term cardiovascular health in children requiring chronic HD.

Original languageEnglish (US)
Pages (from-to)3489-3497
Number of pages9
JournalInternational Journal of Cardiovascular Imaging
Issue number12
StatePublished - Dec 2021
Externally publishedYes


  • Diastolic strain
  • Left atrial strain
  • Mechanical dispersion index
  • Pediatric hemodialysis
  • Speckle tracking echocardiography

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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