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Lupa M, Pardała A, Bednarek A, Mrochem-Kwarciak J, Deja R, Mizia-Stec K, Kolonko A. The Association between Echocardiographic Parameters of Heart Failure with Preserved Ejection Fraction and Fluid Status Biomarkers in Hemodialysis Patients. Diagnostics (Basel) 2024; 14:1310. [PMID: 38928725 PMCID: PMC11202598 DOI: 10.3390/diagnostics14121310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 06/16/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024] Open
Abstract
Overhydration and cardiac function abnormalities are common in hemodialysis patients. The association of N-terminal prohormone for brain natriuretic peptide (NT-proBNP) and other fluid status biomarkers with echocardiographic parameters of heart failure with preserved ejection fraction (HFpEF) is scarcely investigated in this population. A total of 100 separate measurements performed in 50 dialysis patients (29 male, aged 60 ± 17 years) in NYHA class II/II and preserved left ventricle ejection fraction were analyzed. Plasma levels of NT-proBNP, mid-regional prohormone for atrial natriuretic peptide (MR-proANP) and copeptin (CPP) were measured. The E/e' ratio as an index of HFpEF and other echocardiographic parameters were calculated. An E/e' ratio >9 was associated with higher median right ventricular systolic pressure (RVSP) and LVMI values. Left atrium volume index (LAVI) as well as NT-proBNP and MR-proANP, but not CPP levels were significantly higher in this group. In a stepwise multivariate analysis, only CPP and IL-6 levels were found to be independently associated with the E/e' ratio in the study group, whereas NT-proBNP and MR-proANP were associated only with left heart structure parameters and LVEF. Of the analyzed biomarkers, only the CPP level was found to be independently associated with the E/e' ratio in maintenance hemodialysis patients.
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Affiliation(s)
- Mariusz Lupa
- Department of Internal Medicine, District Hospital, 34-600 Limanowa, Poland;
| | | | - Anna Bednarek
- First Department of Cardiology, Medical University of Silesia, 40-635 Katowice, Poland; (A.B.); (K.M.-S.)
| | - Jolanta Mrochem-Kwarciak
- Analytics and Clinical Biochemistry Department, Maria Skłodowska-Curie National Research Institute of Oncology, 44-102 Gliwice, Poland; (J.M.-K.); (R.D.)
| | - Regina Deja
- Analytics and Clinical Biochemistry Department, Maria Skłodowska-Curie National Research Institute of Oncology, 44-102 Gliwice, Poland; (J.M.-K.); (R.D.)
| | - Katarzyna Mizia-Stec
- First Department of Cardiology, Medical University of Silesia, 40-635 Katowice, Poland; (A.B.); (K.M.-S.)
| | - Aureliusz Kolonko
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, 40-027 Katowice, Poland
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Malik J, Valerianova A, Pesickova SS, Hruskova Z, Bednarova V, Michalek P, Polakovic V, Tesar V. CZecking heart failure in patients with advanced chronic kidney disease (Czech HF-CKD): Study protocol. J Vasc Access 2024; 25:294-302. [PMID: 35676802 DOI: 10.1177/11297298221099843] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND Heart failure (HF) is a frequent cause of morbidity and mortality of end-stage kidney disease (ESKD) patients on hemodialysis. It is not easy to distinguish HF from water overload. The traditional HF definition has low sensitivity and specificity in this population. Moreover, many patients on hemodialysis have exercise limitations unrelated to HF. Therefore, we postulated two new HF definitions ((1) Modified definition of the Acute Dialysis Quality Improvement working group; (2) Hemodynamic definition based on the calculation of the effective cardiac output). We hypothesize that the newer definitions will better identify patients with higher number of endpoints and with more advanced structural heart disease. METHODS Cohort, observational, longitudinal study with recording predefined endpoints. Patients (n = 300) treated by hemodialysis in six collaborating centers will be examined centrally in a tertiary cardiovascular center every 6-12 months lifelong or till kidney transplantation by detailed expert echocardiography with the calculation of cardiac output, arteriovenous dialysis fistula flow volume calculation, bio-impedance, and basic laboratory analysis including NTproBNP. Effective cardiac output will be measured as the difference between measured total cardiac output and arteriovenous fistula flow volume and systemic vascular resistance will be also assessed non-invasively. In case of water overload during examination, dry weight adjustment will be recommended, and the patient invited for another examination within 6 weeks. A composite major endpoint will consist of (1) Cardiovascular death; (2) HF worsening/new diagnosis of; (3) Non-fatal myocardial infarction or stroke. The two newer HF definitions will be compared with the traditional one in terms of time to major endpoint analysis. DISCUSSION This trial will differ from others by: (1) detailed repeated hemodynamic assessment including arteriovenous access flow and (2) by careful assessment of adequate hydration to avoid confusion between HF and water overload.
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Affiliation(s)
- Jan Malik
- Third Department of Internal Medicine, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Anna Valerianova
- Third Department of Internal Medicine, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Satu Sinikka Pesickova
- B. Braun Avitum, Dialysis Center Ohradni, Prague, Czech Republic
- Department of Nephrology, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Zdenka Hruskova
- Department of Nephrology, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Vladimira Bednarova
- Department of Nephrology, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Pavel Michalek
- Department of Anaesthesiology and Intensive Medicine, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Vladimir Polakovic
- Internal Department Strahov, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Vladimir Tesar
- Department of Nephrology, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
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Barreto J, Martins M, Pascoa M, Medorima STK, Bonilha I, Jesus DC, Carbonara CEM, Quadros KRS, Assato B, Campos-Staffico AM, Júnior GG, Nadruz W, de Oliveira RB, Sposito AC. Dapagliflozin cardiovascular effects on end-stage kidney disease (DARE-ESKD-2) trial: rationale and design. RESEARCH SQUARE 2023:rs.3.rs-3434207. [PMID: 37886458 PMCID: PMC10602138 DOI: 10.21203/rs.3.rs-3434207/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Purpose Sodium glucose co-transporter 2 inhibitors (SGLT2i) remarkably reduced the incidence of hospitalization for heart failure and cardiovascular death of conservatively managed chronic kidney disease. We hypothesized that adding SGLT2i to standard treatment would yield cardiovascular benefits also in end-stage kidney disease (ESKD) individuals on dialysis. Methods The DARE-ESKD-2 Trial (NCT05685394) is an ongoing, single-center, open-label, controlled trial aimed at assessing the cardiovascular effects of dapagliflozin in ESKD on dialysis. Eligible patients are adults on renal replacement therapy for more than 3 prior to enrollment. Exclusion criteria encompass pregnancy, liver failure, and current use of a SGLT2i. After signing an informed consent form, participants are randomized 1:1 to either dapagliflozin 10mg PO plus standard treatment or standard treatment alone for 6 months. Echocardiogram, anthropometry, blood sample collection, 6-min walk test, gait speed, and Kansas City Cardiomyopathy Questionnaire (KCCQ), are performed at baseline and at study termination. Participants are contacted monthly during treatment for outcomes disclosure. The primary endpoint of our study is the between-groups differences in posttreatment changes in plasma levels of N-terminal pro-B natriuretic peptide. Secondary endpoints include the differences between groups in the changes of echocardiography measurements, cardiopulmonary tests performance, body composition. The incidence of safety endpoints will also be diligently compared between study arms. Conclusion The DARE-ESKD-2 trial will provide unprecedented data on the cardiovascular safety and efficacy of SGLT2i in ESKD individuals on dialysis. This study will pave the grounds for improving clinical outcomes of dialysis recipients.
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Yu X, Zhang D, Chen J, Zhang H, Shen Z, Lv S, Wang Y, Huang X, Zhang X, Zhang C. Heart failure with preserved ejection fraction in haemodialysis patients: prevalence, diagnosis, risk factors, prognosis. ESC Heart Fail 2023; 10:2816-2825. [PMID: 37394269 PMCID: PMC10567676 DOI: 10.1002/ehf2.14447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/28/2023] [Accepted: 06/08/2023] [Indexed: 07/04/2023] Open
Abstract
AIMS Heart failure (HF) is a common complication and the leading cause of mortality in maintenance haemodialysis (MHD) patients. Few studies have investigated heart failure with preserved ejection fraction (HFpEF), which is known to affect a majority of patients. The objective of this study is to explore the prevalence, clinical profiles, diagnosis, risk factors and prognosis of MHD patients with HFpEF. METHODS AND RESULTS Four hundred thirty-nine patients haemodialyzsed for over 3 months were enrolled in the study and evaluated for HF according to the European Society of Cardiology guidelines. Clinical and laboratory parameters were recorded at baseline. The median follow-up of the study was 22.5 months. A total of 111 (25.3%) MHD patients were diagnosed with HF, while 94 (84.7%) of the HF patients were classified into HFpEF. The cut-off value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) was 4922.5 pg/mL for predicting HFpEF (sensitivity 0.840, specificity 0.723, AUC 0.866) in MHD patients. Age, diabetes mellitus, coronary artery disease and serum phosphorus were independent risk factors for the incidence of HFpEF in MHD patients while normal urine volume, haemoglobin, serum iron and serum sodium were protective factors. MHD patients with HFpEF had a higher risk of all-cause mortality than those without HF (hazard ratio 2.47, 95% confidence interval 1.55-3.91, P < 0.0001). CONCLUSIONS The majority of MHD patients with HF were categorized into HFpEF, with a poor long-term survival rate. NT-proBNP beyond 4922.5 pg/mL performed well in the prediction of HFpEF in MHD patients.
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Affiliation(s)
- Xixi Yu
- Department of Nephrology, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Di Zhang
- Kidney and Dialysis Institute of ShanghaiShanghaiChina
- Shanghai Key Laboratory of Kidney and Blood PurificationShanghaiChina
| | - Jing Chen
- Department of NephrologyZhongshan Hospital, Fudan UniversityShanghaiChina
- Kidney and Dialysis Institute of ShanghaiShanghaiChina
| | - Han Zhang
- Department of NephrologyZhongshan Hospital, Fudan UniversityShanghaiChina
- Kidney and Dialysis Institute of ShanghaiShanghaiChina
| | - Ziyan Shen
- Department of NephrologyZhongshan Hospital, Fudan UniversityShanghaiChina
- Kidney and Dialysis Institute of ShanghaiShanghaiChina
| | - Shiqi Lv
- Kidney and Dialysis Institute of ShanghaiShanghaiChina
- Shanghai Key Laboratory of Kidney and Blood PurificationShanghaiChina
| | - Yulin Wang
- Kidney and Dialysis Institute of ShanghaiShanghaiChina
- Shanghai Key Laboratory of Kidney and Blood PurificationShanghaiChina
| | - Xinhui Huang
- Kidney and Dialysis Institute of ShanghaiShanghaiChina
- Shanghai Key Laboratory of Kidney and Blood PurificationShanghaiChina
| | - Xiaoyan Zhang
- Department of NephrologyZhongshan Hospital, Fudan UniversityShanghaiChina
- Kidney and Dialysis Institute of ShanghaiShanghaiChina
- Shanghai Key Laboratory of Kidney and Blood PurificationShanghaiChina
| | - Chun Zhang
- Department of Nephrology, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
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Lei Y, Tong J, Su Y, Wang Y, Zhong B, Wang Q, Zhang Y. Risk factors of left ventricular diastolic dysfunction in maintenance hemodialysis patients. BMC Nephrol 2023; 24:166. [PMID: 37308865 DOI: 10.1186/s12882-023-03220-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 05/29/2023] [Indexed: 06/14/2023] Open
Abstract
OBJECTIVE To investigate the risk factors of left ventricular diastolic dysfunction in maintenance hemodialysis (MHD) patients. METHOD We retrospectively collected data from 363 hemodialysis patients who were on dialysis for at least 3 months at January 1, 2020. According to the echocardiogram results, these patients were divided into left ventricular diastolic dysfunction (LVDD) group and non-LVDD group. The differences in basic data, cardiac structure and functiona between the two groups were analyzed. Logistic regression analysis was used to analyze the risk factors of cardiac diastolic dysfunction in MHD patients. RESULTS Compared with the non-LVDD group, patients in the LVDD group were older, with an increased proportion of coronary heart disease, more prone to chest tightness, shortness of breath. Simultaneously, they had a significantly increased (p < 0.05) proportion of cardiac structural abnormalities such as left ventricular hypertrophy, left heart enlargement and systolic dysfunction. Multivariate logistic regression analysis showed that the risk of LVDD was significantly increased in elderly MHD patients older than 60 years (OR = 3.86, 95%CI 1.429-10.429), and left ventricular hypertrophy was also significantly associated with LVDD (OR = 2.227, 95% CI 1.383-3.586). CONCLUSION According to research, both age and left ventricular hypertrophy are risk factors for LVDD in MHD patients. It is recommended that early intervention for LVDD should be implemented to improve the quality of dialysis and reduce the incidence of cardiovascular events in MHD patients.
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Affiliation(s)
- Ying Lei
- Department of Nephrology, Huadu District People's Hospitalof Guangzhou, Southern Medical University, Guangzhou, 510800, China
| | - JinYan Tong
- Department of Nephrology, Huadu District People's Hospitalof Guangzhou, Southern Medical University, Guangzhou, 510800, China
| | - YanYan Su
- Department of Nephrology, Huadu District People's Hospitalof Guangzhou, Southern Medical University, Guangzhou, 510800, China
| | - YuQuan Wang
- Department of Nephrology, Huadu District People's Hospitalof Guangzhou, Southern Medical University, Guangzhou, 510800, China
| | - BiXian Zhong
- Department of Nephrology, Huadu District People's Hospitalof Guangzhou, Southern Medical University, Guangzhou, 510800, China
| | - Qi Wang
- Department of Nephrology, Huadu District People's Hospitalof Guangzhou, Southern Medical University, Guangzhou, 510800, China
| | - YunFang Zhang
- Department of Nephrology, Huadu District People's Hospitalof Guangzhou, Southern Medical University, Guangzhou, 510800, China
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Asarcikli LD, Can F, Guvenc TS, Sert S, Osken A, Dayi SU. The effect of urgent blood pressure reduction on left atrial strain in patients with hypertensive attack : Blood pressure lowering affects LA strain. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023:10.1007/s10554-023-02828-8. [PMID: 37093309 DOI: 10.1007/s10554-023-02828-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 03/03/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Left atrial (LA) strain is a robust measure of LA function and is a useful parameter to assess left ventricular filling pressure. While initially considered as a "load-independent" parameter of LA function, later studies have found that acute changes in LA preload may affect LA reservoir and contractile strains. Acute alterations in blood pressure (BP) induces a change in left ventricular (LV) filling pressure without imposing a volume load, thus providing an opportunity to assess the effects of the change in LA afterload on LA mechanics. This study aims to understand the effect of acute BP changes on LA strain. METHODS A total of 40 patients admitted to the emergency department with hypertensive urgency were included. All patients underwent a comprehensive echocardiographic examination including measurement of LA reservoir, conduit and contractile strains. A repeat set of measurements were obtained after BP lowering. RESULTS Average drop in mean BP following intervention was 18.1 ± 5.4%. LV end-systolic and end-diastolic volumes, as well as maximum and minimum LA volumes were decreased significantly after BP reduction. The absolute increases in reservoir and contractile strains were 2.3 ± 4.7% (7.9% ± 13.8% relative to baseline) and 2.5 ± 3.3% (13.5 ± 19.0% relative to baseline), respectively, with both changes being statistically significant (p = 0.003 for reservoir and p < 0.001 for contractile strains). There were no significant changes in conduit strain after BP intervention (p = 0.79). The change in both LA reservoir and contractile strains were more evident in those with a previous diagnosis of hypertension and those with a smaller degree of change in mean BP after intervention. CONCLUSION In patients with an acute hypertension, lowering BP leads to an acute improvement in LA reservoir and contractile strains. Thus, acute changes in systemic BP should be considered when LA mechanics are evaluated.
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Affiliation(s)
- Lale Dinc Asarcikli
- Department of Cardiology, Dr. Siyami Ersek Cardiovascular and Thoracic Surgery Research and Training Hospital, Tibbiye Street No:13, 34668, Istanbul, Kadikoy, Turkey.
| | - Fatma Can
- Department of Cardiology, Dr. Siyami Ersek Cardiovascular and Thoracic Surgery Research and Training Hospital, Tibbiye Street No:13, 34668, Istanbul, Kadikoy, Turkey
| | - Tolga Sinan Guvenc
- Department of Cardiology, Istinye University School of Medicine, Istanbul, Turkey
| | - Sena Sert
- Department of Cardiology, Dr. Siyami Ersek Cardiovascular and Thoracic Surgery Research and Training Hospital, Tibbiye Street No:13, 34668, Istanbul, Kadikoy, Turkey
| | - Altug Osken
- Department of Cardiology, Dr. Siyami Ersek Cardiovascular and Thoracic Surgery Research and Training Hospital, Tibbiye Street No:13, 34668, Istanbul, Kadikoy, Turkey
| | - Sennur Unal Dayi
- Department of Cardiology, Dr. Siyami Ersek Cardiovascular and Thoracic Surgery Research and Training Hospital, Tibbiye Street No:13, 34668, Istanbul, Kadikoy, Turkey
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Akbay E, Akinci S, Coner A, Adar A, Genctoy G, Demir AR. New perspective on fatigue in hemodialysis patients with preserved ejection fraction: diastolic dysfunction : Fatigue and diastolic dysfunction. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:2143-2153. [PMID: 37726453 DOI: 10.1007/s10554-022-02609-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/25/2022] [Indexed: 11/05/2022]
Abstract
The relationship between diastolic dysfunction and fatigue in hemodialysis patients with preserved ejection fraction is unknown. In this context, the objective of this study is to assess fatigue using the relevant scales and to demonstrate its relationship with diastolic dysfunction. The patients who underwent hemodialysis were evaluated prospectively. Patients' fatigue was assessed using the Visual Analogue Scale to Evaluate Fatigue Severity (VAS-F). The echocardiographic works were performed as recommended in the American Society of Echocardiography guidelines. A total of 94 patients [mean age 64.7 ± 13.5 years, 54 males (57.4%)] were included in the study. The median VAS-F score of these patients was 68.5 (33.25-91.25), and they were divided into two groups according to this value. Peak myocardial velocities during early diastole (e') and tricuspid annular plane systolic excursion (TAPSE) values were found to be significantly lower in the group with high VAS-F scores, whereas the early diastolic flow velocities (E)/e' ratio and pulmonary artery peak systolic pressures (PAP) were found to be significantly higher (p < 0.05, for all). E/e' ratio (r 0.311, p 0.002) and PAP (r 0.281, p 0.006) values were found to be positively correlated with the VAS-F score, as opposed to the TAPSE (r - 0.257, p 0.012) and e' (r - 0.303, p 0.003) values, which were found to be negatively correlated with the VAS-F score. High fatigue scores in hemodialysis patients may be associated with diastolic dysfunction. In addition, in our study, we determined the correlation of VAS-F score with E/e' ratio, PAP and TAPSE.
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Affiliation(s)
- Ertan Akbay
- Department of Cardiology, Alanya Medical and Research Center, Baskent University Hospital, Saray Mahallesi Yunus Emre Caddesi No: 1, 07400, Alanya, Turkey.
| | - Sinan Akinci
- Department of Cardiology, Alanya Medical and Research Center, Baskent University Hospital, Saray Mahallesi Yunus Emre Caddesi No: 1, 07400, Alanya, Turkey
| | - Ali Coner
- Department of Cardiology, Alanya Medical and Research Center, Baskent University Hospital, Saray Mahallesi Yunus Emre Caddesi No: 1, 07400, Alanya, Turkey
| | - Adem Adar
- Department of Cardiology, Alanya Medical and Research Center, Baskent University Hospital, Saray Mahallesi Yunus Emre Caddesi No: 1, 07400, Alanya, Turkey
| | - Gultekin Genctoy
- Department of Nephrology, Alanya Medical and Research Center, Baskent University Hospital, Alanya, Turkey
| | - Ali Riza Demir
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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Sun M, Xing Y, Guo Y, Cao X, Nie Y, Shu X. Left atrial reservoir strain is an outstanding predictor of adverse cardiovascular outcomes in patients undergoing maintenance hemodialysis: Assessment via three-dimensional speckle tracking echocardiography. Clin Cardiol 2022; 45:549-557. [PMID: 35312072 PMCID: PMC9045074 DOI: 10.1002/clc.23815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 02/14/2022] [Accepted: 03/03/2022] [Indexed: 11/13/2022] Open
Abstract
Background There is a paucity of literature focusing left atrium (LA) in patients undergoing maintenance hemodialysis (MHD). Hypothesis We used three‐dimensional speckle tracking echocardiography (3DSTE) to evaluate LA in MHD patients and to explore its predictive value for adverse outcomes. Methods Echocardiography was performed on 130 consecutively enrolled MHD patients without previous cardiac diseases. Conventional and 3DSTE parameters of LA were obtained. The MHD cohort was then followed and the end point was major adverse cardiovascular events (MACEs). LA strain indices, including reservoir strain (LASr), conduit strain (LAScd), and contractile strain (LASct), were measured and compared between patients with and without MACEs. Results Patients were prospectively followed up for a median of 40.5 (interquartile range: 26.3–48.0) months. During follow‐up, 43 patients met the end point. These patients had larger LA size and reduced LA strains (LA maximal volume indexed: 45.1 ± 11.9 vs. 33.8 ± 6.9ml/m2; LASr: 20.2 ± 3.5 vs. 27.2 ± 3.3%; LAScd: −12.3 ± 5.2 vs. −14.5±4.0%; LASct: −8.0 ± 4.2 vs. −13.2 ± 3.7%; all p<.05), compared with those without MACEs. Multivariable regression analysis showed LASr was the strongest predictor of MACEs (hazard ratio, 0.69; 95% confidence interval, 0.54–0.89; p=.004). Univarite Kaplan–Meier analysis revealed the incidence of MACEs in the impaired LASr (<24.2%) group was significantly higher than in the normal LASr group (log rank p<.001). Conclusions LASr derived from 3DSTE is an independent predictor of MACEs and cardiac death in MHD patients, superior to LV parameters and LA volume indices.
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Affiliation(s)
- Minmin Sun
- Department of Echocardiography, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yumeng Xing
- Department of Echocardiography, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yao Guo
- Department of Echocardiography, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xuesen Cao
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuxin Nie
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xianhong Shu
- Department of Echocardiography, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, China
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Valerianova A, Malik J, Janeckova J, Kovarova L, Tuka V, Trachta P, Lachmanova J, Hladinova Z, Hruskova Z, Tesar V. Reduction of arteriovenous access blood flow leads to biventricular unloading in haemodialysis patients. Int J Cardiol 2021; 334:148-153. [PMID: 33895210 DOI: 10.1016/j.ijcard.2021.04.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 04/04/2021] [Accepted: 04/16/2021] [Indexed: 12/28/2022]
Abstract
AIMS Patients on chronic haemodialysis have a wide range of changes in cardiac function and structure, including left ventricular hypertrophy, dilation and diastolic dysfunction or pulmonary hypertension. All these changes were linked to increased mortality in previous studies. High-flow arteriovenous fistulas (AVF) are supposed to be a factor contributing to their development. This study investigated the early effect of surgical AVF blood flow (Qa) reduction on these changes in patients with or without heart failure changes. METHODS AND RESULTS Forty-two patients in chronic haemodialysis programme with high-flow AVF (Qa over 1500 mL/min), indicated for surgery for ≥1 of the following indications: 1.manifest heart failure; 2.hand ischemia; 3.advanced structural heart changes detected by echocardiography. The patients underwent echocardiography on selection visit, before blood flow reducing surgery and six weeks thereafter. The Qa reduction led to decrease of left ventricular mass (p = 0.02), end-diastolic volume (p = 0.008), end-diastolic diameter (p = 0.003) and left atrial volume (p = 0.0006). Diastolic function improved. Similarly, right ventricular diameter and right atrial volume decreased (p = 0.000001 and 0.00009, respectively) together with the decrease of estimated pulmonary artery systolic pressure. 81% of patients suffered from pulmonary hypertension prior to surgery, only 36% thereafter. CONCLUSION The surgical restriction of the hyperkinetic circulation leads to several improvements of heart structure and function, which was linked to higher mortality in other studies. The beneficial effect of Qa reduction is present even in patients without symptoms of heart failure. The contribution of AVF must be considered with structural or functional heart changes.
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Affiliation(s)
- Anna Valerianova
- 3(rd) Department of Internal Medicine, 1(st) Faculty of Medicine, Charles University, General University Hospital in Prague, U Nemocnice 1, 128 08 Prague, Czech Republic.
| | - Jan Malik
- 3(rd) Department of Internal Medicine, 1(st) Faculty of Medicine, Charles University, General University Hospital in Prague, U Nemocnice 1, 128 08 Prague, Czech Republic
| | - Jana Janeckova
- II. Department of Surgery, University Hospital in Olomouc, I.P. Pavlova 185/6, 779 00 Olomouc, Czech Republic
| | - Lucie Kovarova
- 3(rd) Department of Internal Medicine, 1(st) Faculty of Medicine, Charles University, General University Hospital in Prague, U Nemocnice 1, 128 08 Prague, Czech Republic
| | - Vladimir Tuka
- 3(rd) Department of Internal Medicine, 1(st) Faculty of Medicine, Charles University, General University Hospital in Prague, U Nemocnice 1, 128 08 Prague, Czech Republic
| | - Pavel Trachta
- 3(rd) Department of Internal Medicine, 1(st) Faculty of Medicine, Charles University, General University Hospital in Prague, U Nemocnice 1, 128 08 Prague, Czech Republic
| | - Jana Lachmanova
- Department of Nephrology, 1(st) Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 08 Prague, Czech Republic
| | - Zuzana Hladinova
- Department of Nephrology, 1(st) Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 08 Prague, Czech Republic
| | - Zdenka Hruskova
- Department of Nephrology, 1(st) Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 08 Prague, Czech Republic
| | - Vladimir Tesar
- Department of Nephrology, 1(st) Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 08 Prague, Czech Republic
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Hauser T, Dornberger V, Malzahn U, Grebe SJ, Liu D, Störk S, Nauck M, Friedrich N, Dörr M, Wanner C, Krane V, Hammer F. The effect of spironolactone on diastolic function in haemodialysis patients. Int J Cardiovasc Imaging 2021; 37:1927-1936. [PMID: 33544240 PMCID: PMC8255262 DOI: 10.1007/s10554-021-02176-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/25/2021] [Indexed: 11/25/2022]
Abstract
Heart failure with preserved ejection fraction (HFpEF) is highly prevalent in patients on maintenance haemodialysis (HD) and lacks effective treatment. We investigated the effect of spironolactone on cardiac structure and function with a specific focus on diastolic function parameters. The MiREnDa trial examined the effect of 50 mg spironolactone once daily versus placebo on left ventricular mass index (LVMi) among 97 HD patients during 40 weeks of treatment. In this echocardiographic substudy, diastolic function was assessed using predefined structural and functional parameters including E/e’. Changes in the frequency of HFpEF were analysed using the comprehensive ‘HFA-PEFF score’. Complete echocardiographic assessment was available in 65 individuals (59.5 ± 13.0 years, 21.5% female) with preserved left ventricular ejection fraction (LVEF > 50%). At baseline, mean E/e’ was 15.2 ± 7.8 and 37 (56.9%) patients fulfilled the criteria of HFpEF according to the HFA-PEFF score. There was no significant difference in mean change of E/e’ between the spironolactone group and the placebo group (+ 0.93 ± 5.39 vs. + 1.52 ± 5.94, p = 0.68) or in mean change of left atrial volume index (LAVi) (1.9 ± 12.3 ml/m2 vs. 1.7 ± 14.1 ml/m2, p = 0.89). Furthermore, spironolactone had no significant effect on mean change in LVMi (+ 0.8 ± 14.2 g/m2 vs. + 2.7 ± 15.9 g/m2; p = 0.72) or NT-proBNP (p = 0.96). Treatment with spironolactone did not alter HFA-PEFF score class compared with placebo (p = 0.63). Treatment with 50 mg of spironolactone for 40 weeks had no significant effect on diastolic function parameters in HD patients. The trial has been registered at clinicaltrials.gov (NCT01691053; first posted Sep. 24, 2012).
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Affiliation(s)
- T Hauser
- Division of Nephrology, Department of Medicine I, University Hospital Würzburg, Oberduerrbacher Str. 6, 97080, Wuerzburg, Germany.
| | - V Dornberger
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - U Malzahn
- Clinical Trial Centre, University Hospital Würzburg, Würzburg, Germany
| | - S J Grebe
- Department of Paediatrics, University Hospital of Erlangen, Erlangen, Germany
| | - D Liu
- Division of Nephrology, Department of Medicine I, University Hospital Würzburg, Oberduerrbacher Str. 6, 97080, Wuerzburg, Germany
- Comprehensive Heart Failure Centre, University and University Hospital Würzburg, Würzburg, Germany
| | - S Störk
- Division of Nephrology, Department of Medicine I, University Hospital Würzburg, Oberduerrbacher Str. 6, 97080, Wuerzburg, Germany
- Comprehensive Heart Failure Centre, University and University Hospital Würzburg, Würzburg, Germany
| | - M Nauck
- Institute for Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany
| | - N Friedrich
- Institute for Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - M Dörr
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany
| | - C Wanner
- Division of Nephrology, Department of Medicine I, University Hospital Würzburg, Oberduerrbacher Str. 6, 97080, Wuerzburg, Germany
- Comprehensive Heart Failure Centre, University and University Hospital Würzburg, Würzburg, Germany
| | - V Krane
- Division of Nephrology, Department of Medicine I, University Hospital Würzburg, Oberduerrbacher Str. 6, 97080, Wuerzburg, Germany
- Comprehensive Heart Failure Centre, University and University Hospital Würzburg, Würzburg, Germany
| | - F Hammer
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
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Xu Y, Li X, Zuo X, Jia H, Han E, Liang F, Xie L, Gao J. Effects of coenzyme Q10 on endothelial and cardiac function in patients undergoing haemodialysis: study protocol for a pilot randomised controlled trial. BMJ Open 2020; 10:e036732. [PMID: 32873669 PMCID: PMC7467521 DOI: 10.1136/bmjopen-2019-036732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Endothelial and cardiac dysfunction are highly prevalent and are associated with cardiovascular morbidity and mortality among patients undergoing dialysis. For patients undergoing dialysis, no study has explored the effect of supplementation of coenzyme Q10 (CoQ10) on endothelial function. To our best of knowledge, only two small sample studies focused on the efficacy of supplementation of CoQ10 on cardiac function. However, the effect of CoQ10 supplementation on cardiac function remains uncertain in patients who undergo haemodialysis. The aim of this study is to explore whether CoQ10 supplementation can improve endothelial and cardiac function in patients undergoing haemodialysis. METHODS AND ANALYSIS This is a pilot randomised controlled study. Eligible patients undergoing haemodialysis in our haemodialysis centre will be randomly allocated to the CoQ10 and control groups. The follow-up time is 12 months. The primary outcome is to assess the change of brachial artery endothelial-dependent flow-mediated dilation, left ventricular systolic function, diastolic function and Myocardial Performance Index at 12 months from baseline. Secondary outcomes are death or hospitalisation due to cardiovascular events, all-cause mortality, change of CoQ10 concentration, the ratio of ubiquinol to ubiquinone, the change of oxidative stress markers (including malondialdehyde and 8-hydroxy-deoxyguanosine) and Left Ventricular Mass Index. ETHICS AND DISSEMINATION Risks associated with CoQ10 are minor, even at doses as high as 1800 mg according to previous studies. The trial has received ethics approval from the Medical Ethics Committee for Clinical Trials of Drugs, the 306th Hospital of Chinese PLA. The results of the study are expected to be published in a peer-reviewed journal and presented at academic conferences. TRIAL REGISTRATION NUMBER ChiCTR1900022258.
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Affiliation(s)
- Yongxing Xu
- Department of Nephrology, Chinese PLA Strategic Support Force Characteristic Medical Center (The 306th Hospital of Chinese PLA), Beijing, China
| | - Xinlou Li
- Department of Medical Research, Chinese PLA Strategic Support Force Characteristic Medical Center (The 306th Hospital of Chinese PLA), Beijing, China
| | - Xiaowen Zuo
- Department of Ultrasound in Medicine, Chinese PLA Strategic Support Force Characteristic Medical Center (The 306th Hospital of Chinese PLA), Beijing, China
| | - Huaping Jia
- Department of Ultrasound in Medicine, Chinese PLA Strategic Support Force Characteristic Medical Center (The 306th Hospital of Chinese PLA), Beijing, China
| | - Enhong Han
- Department of Nephrology, Chinese PLA Strategic Support Force Characteristic Medical Center (The 306th Hospital of Chinese PLA), Beijing, China
| | - Fugui Liang
- Department of Nephrology, Chinese PLA Strategic Support Force Characteristic Medical Center (The 306th Hospital of Chinese PLA), Beijing, China
| | - Lei Xie
- Department of Nephrology, Chinese PLA Strategic Support Force Characteristic Medical Center (The 306th Hospital of Chinese PLA), Beijing, China
| | - Jianjun Gao
- Department of Nephrology, Chinese PLA Strategic Support Force Characteristic Medical Center (The 306th Hospital of Chinese PLA), Beijing, China
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