Prognostic Value of Cardiac Troponin I and Left Ventricular Geometry in Pediatric Chronic Hemodialysis: A One Year Follow Up Study

Increase in left ventricular mass index (LVMI) is associated with an increase in the incident risk of fatal and nonfatal cardiovascular events in chronic renal failure (CRF). Cardiac troponin I (cTnl) has been shown to be specific for myocardial damage in chronic dialysis patients. Objective: To assess LVMI and cTnl in pediatric patients with CRF on chronic hemodialysis (HD) and to determine their relation to dialytic hypotensive episodes as well as mortality over a period of one year. Patients and Methods: A prospective follow up study was conducted on 30 pediatric patients with CRF on chronic regular HD with a mean age (10.3±3.04 years). Cases were subjected to clinical evaluation, 2- D, M-mode, pulsed and color Doppler echocardiography. Calculation of left ventricular mass (LVM) and LVMI were done. Assessment of cTnl using one-step serum immunoassay test was performed. Cases were clinically followed up for 1 year for dialytic hypotensive episodes and mortality. Results: LVMI was increased in 20 cases (66.7%). Concentric hypertrophy was present in 13 patients and eccentric hypertrophy was detected in 7 patients. Another six cases had concentric remodeling. All cases were negative for cTnl. There was a statistically significant difference between CRF patients with LVH and those with normal LVM as regards pH, HC03 and left ventricular posterior wall thickness (LVPW) (p 0.05). A positive correlation markedly approaching significance was found between fractional shortening (FS) and body mass index (BMI) (r=0.35, p=0.05). Mortality was 10% and hypotensive episodes occurred in 13.3% of the cases. The positive predictive value of LVMI to mortality was 28.6%, negative predictive value 95.7% with 81.5% specificity and 66.7% sensitivity. Low FS was an excellent predictor of mortality in the studied cases with positive predictive value 100%, and negative predictive value 96.4% with 100% specificity and 66.7% sensitivity. Conclusion: Normal cardiac Troponin I does not preclude cardiovascular risk in chronic hemodialysis patients. Increased LVMI and low FS are useful predictors of mortality in chronic pediatric hemodialysis patients.