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All participants underwent thorough clinical examination, laboratory investigations, 24-h Holter monitoring, and 2D\/4D echocardiographic study (conventional and advanced modalities). Participants were followed for mortality and morbidity over 36\u00a0months.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Following HD sessions, CKD children showed significant reductions of left and right ventricular (LV\/RV) systolic function by 2D and 4D echocardiography compared to controls. HD children had significant impairment of heart rate variability parameters (evaluated by time and frequency domains). LV\/RV global longitudinal shortening (GLS) as well as tricuspid annular plane systolic excursion were closely correlated with different Holter parameters, including frequency domain parameters (including low frequency, high frequency, and LF\/HF ratio), time domain parameters including percentage of differences\u2009&gt;\u200950\u00a0ms between consecutive normal RR intervals (pNN50), and root-mean-square of the difference between successive normal intervals (rMSSD). Over a follow-up of 34.5\u2009\u00b1\u200916.8\u00a0months, 10 (25%) patients died. Reduced LV\/RV-GLS and decreased rMSSD values were independently associated with higher mortality among HD children.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>LV and RV myocardial deformation (either 2D or 4D) primarily decreased in HD children. Altered time and frequency domain indices revealed cardiac autonomic dysfunction, evidenced by increased sympathetic activity and decreased vagal activity. Reduced LV\/RV-GLS and decreased rMSSD values were independently associated with higher mortality among HD children.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Graphical abstract<\/jats:title>\n          <\/jats:sec>","DOI":"10.1007\/s00467-024-06577-1","type":"journal-article","created":{"date-parts":[[2025,1,28]],"date-time":"2025-01-28T07:52:25Z","timestamp":1738050745000},"page":"2599-2610","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["The association between systolic and diastolic dysfunction and autonomic nervous system function in children receiving chronic hemodialysis"],"prefix":"10.1007","volume":"40","author":[{"given":"Ola H. 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