Background

• We have previously shown in pediatric CKD patients a high prevalence of left ventricular (LV) hypertrophy (Matteucci MC et al. JASN, 2006)
• Current guidelines suggest that left ventricular (LV) hypertrophy should be defined by traditional indexation of LV mass to the allometric power of 2.7.
• However, we have recently reported that indexation of LV mass to the allometric power of 2.7, as, may result in a significant overestimation of LV hypertrophy in younger children.
• Accordingly, we have suggested a simplified indexation approach to overcome this issue (Chinali M. J Peds, 2016).

 FIG. 1

AIM & METHODS

AIM: Objective of the present study was to verify whether our proposed indexation improves risk stratification in CKD children

METHODS: Overall 547 children with available echocardiographic data, from two multicenter European studies on CKD were included (237 from the Escape trial and 310 from the 4C study).

Presence of LV hypertrophy was defined using partition values suggested by current guidelines (LVM>38g/m2.7) and by our recently suggested approach [LVM>(45g/(m2.16+0.09)].

Differences in the two methods in the identification of children with impaired systolic function were reported.  

Results

FIG.2 - FIG.3 - FIG.4

Conclusions

• Despite general accordance among methods, traditional definition of LV hypertrophy overestimates the prevalence of LVH in children with CKD.
• Overestimation is more prominent in the very young children, in which no abnormalities in cardiac function can be found (false positives).
• In addition, in a subgroup of patient without traditionally defined LVH, our novel approach identifies LVH associated with a cardiac phenotype similar to patients with “agreed LVH” (false negatives).
• Our proposed simplified approach for the definition of LV hypertrophy overcomes these issues, significantly improving risk stratification in CKD children.