Global longitudinal strain by speckle-tracking outperforms conventional echocardiography across pediatric chronic kidney disease severity

Background: Cardiovascular involvement is one of the causes of increased morbidity and mortality rates in patients with chronic kidney disease (CKD). Limited data on cardiovascular complications have been reported in children with CKD. Most children with CKD have well-preserved left ventricular function as assessed using conventional echocardiography. This study aimed to analyze the correlation between left ventricular function assessed using speckle-tracking echocardiography (STE) and estimated glomerular filtration rate (eGFR) in pediatric CKD. Methods: A cross-sectional analytic study from June to September 2025 of 38 children diagnosed with CKD were visited Dr Hasan Sadikin General Hospital, Bandung, Indonesia, for inpatient and outpatient care. Each subject underwent laboratory examinations for creatinine levels, conventional echocardiography, and STE using a Philips EPIQ machine performed by a pediatric cardiologist consultant on the same day. Stage of CKD determined by eGFR using the Schwartz formula from the creatinine results. Data were analyzed using unpaired t-test, ANOVA, and Spearman’s rho correlation test. Results: Of the 38 children with CKD, 52.6% were male, with a median age of 14.04 years. Glomerular diseases, mostly focal segmental glomerulonephritis and lupus nephritis, were the most common cause in this study (89.4%). Variable CKD severity was observed in this study (39.5% of stage 1), followed by 28.9% (stage 5). A significant positive correlation was found between left ventricular function (ejection fraction/EF, fractional shortening/FS, and global longitudinal strain/GLS) measured by speckle-tracking echocardiography and eGFR (r = 0.385, p = 0.017; r = 0.358, p = 0.027; r = 0.417, p = 0.009, respectively). Conclusion: Left ventricular function (EF, FS, and GLS) assessed using STE positively correlated with eGFR. Speckle-tracking echocardiography can be used as a routine examination and modality to identify subclinical left ventricular dysfunction in pediatric CKD patients with a preserved ejection fraction.