Author + information
- Received December 11, 1986
- Revision received May 15, 1987
- Accepted May 20, 1987
- Published online November 1, 1987.
- Steven D. Colan, MD, FACC*,1,
- Stephen P. Sanders, MD1,
- Julie R. Ingelfinger, MD1 and
- William Harmon, MD1
- ↵*Address for reprints: Steven D. Colan, MD, Department of Cardiology, Children's Hospital, 300 Longwood Avenue, Boston, Massachusetts 02115.
The potential existence of a specific uremia-associated myocardial depressant factor was explored by evaluating nine pediatric subjects (3 to 21 years) without evidence of coronary artery disease or long-standing hypertension 1) before entering a dialysis program, 2) while undergoing a long-term dialysis regimen, and 3) after successful renal transplantation. Myocardial contractility was quantitated with load-independent indexes using the end-systolic pressure-dimension relation (Emax) and the relation of rate-corrected velocity of shortening to end-systolic wall stress. Myocardial loading status was determined by the direct measurement of afterload (end-systolic wall stress) and the functional quantitation of preload (differences between the relation of fractional shortening and velocity of shortening to end-systolic stress).
Most patients (55%) were found to have abnormal ejection phase indexes of ventricular function either before or after entry into dialysis. However, contractility was normal in all subjects at each of their evaluations, and no change in contractility was found after dialysis or transplantation. Loading status was highly variable and usually abnormal before transplantation and accounted entirely for the abnormalities of fractional shortening and velocity of shortening. Transplantation invariably resulted in normalization of loading status and ejection phase indexes of ventricular function.
In these children and young adults with uremia, abnormal ejection phase indexes of ventricular function were frequent and caused by associated abnormalities in ventricular loading. Contractility, however, was normal and no evidence of a uremia-associated myocardial depressant was found.
- Received December 11, 1986.
- Revision received May 15, 1987.
- Accepted May 20, 1987.
- American College of Cardiology Foundation