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Li L, You C, Zhang L, Yang J, Wang Y, Zhang P. Prognostic values of left atrial strain analyzed by four-dimensional speckle tracking echocardiography in uremia with preserved ejection fraction. Sci Rep 2024; 14:18971. [PMID: 39152294 PMCID: PMC11329677 DOI: 10.1038/s41598-024-69904-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 08/09/2024] [Indexed: 08/19/2024] Open
Abstract
Little is known about the prognostic value of left atrial strain by four-dimensional speckle-tracking echocardiography in end-stage renal disease patients with preserved left ventricular ejection fraction. This prospective study collected clinical and echocardiographic data from 80 stable dialysis patients (mean age 57 ± 10 years; 62.5% men). All patients underwent the dedicated four-dimensional speckle-tracking echocardiography to measure LASr (peak longitudinal strain of reservoir function), LAScd (peak longitudinal strain of conduit function), LASct (peak longitudinal strain of contractile function), LASr_c (peak circumferential strain of reservoir function), LAScd_c (peak circumferential strain of conduit function) and LASct_c (peak circumferential strain of contractile function). These patients were enrolled from August 2021 to August 2023 and followed-up for 19 months (interquartile-range 15 to 20 months). The primary outcome was a composite of all-cause mortality or major adverse cardiovascular events (MACEs). The study patients were classified into event (developed mortality or MACEs) and event-free group according to the primary outcome. Multivariate Cox regression analysis was used to investigate risk factors for all-cause mortality or MACEs. The event group had lower LASr (16.4% vs. 21.2%, P = 0.0003), LASct (8.2% vs. 11.2%, P = 0.01), LASr_c (25.2% vs. 35.0%, P = 0.0004) and LASct_c (14.9% vs. 20.9%, P = 0.001) than the event-free group. Using optimal cut-off value determined by ROC curve, the less LASr (LASr < 18.5%), LASct (LASct < 8.5%), LASr_c (LASr_c < 28.5%), and LASct_c (LASct_c < 17.5%) group had a higher mortality or MACEs rate. Multivariate cox regression analyses revealed that LASr (HR = 0.81, 95% CI [0.17; 0.91], P = 0.0005, per 1% increase) and LASr_c (HR = 0.93, 95% CI [0.87; 0.98], P = 0.01, per 1% increase) were independent predictors of all-cause mortality or MACEs. Less peak longitudinal and circumferential strains of reservoir function are predictive of poor prognosis among end-stage renal disease patients with preserved left ventricular ejection fraction.
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Affiliation(s)
- Lei Li
- Department of Echocardiography, Nanjing First Hospital, Nanjing Medical University, Changle Road 68, Nanjing, 210006, Jiangsu Province, China
- Department of Cardiology, Wuxi No.2 People's Hospital, Wuxi, 214000, China
- Department of Cardiology, Jiangnan University Medical Center, Wuxi, 214000, China
| | - Chunyuan You
- Department of Cardiology, Wuxi No.2 People's Hospital, Wuxi, 214000, China
- Department of Cardiology, Jiangnan University Medical Center, Wuxi, 214000, China
| | - Lai Zhang
- Department of Nephrology, Wuxi No.2 People's Hospital, Wuxi, 214000, China
| | - Jun Yang
- Department of Cardiology, Wuxi No.2 People's Hospital, Wuxi, 214000, China
- Department of Cardiology, Jiangnan University Medical Center, Wuxi, 214000, China
| | - Yang Wang
- Department of Cardiology, Wuxi No.2 People's Hospital, Wuxi, 214000, China
- Department of Cardiology, Jiangnan University Medical Center, Wuxi, 214000, China
| | - Pingyang Zhang
- Department of Echocardiography, Nanjing First Hospital, Nanjing Medical University, Changle Road 68, Nanjing, 210006, Jiangsu Province, China.
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Oktan MA, Korucu B, Çolak A, Bildacı YD, Çavdar C, Değer SM. The relationship between changes in peritoneal membrane solute transfer characteristics and cardiac remodeling in patients with peritoneal dialysis. Ther Apher Dial 2024. [PMID: 38837848 DOI: 10.1111/1744-9987.14170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 04/20/2024] [Accepted: 05/15/2024] [Indexed: 06/07/2024]
Abstract
INTRODUCTION We aimed to determine the relationship between the dilatation of the heart chambers and the change in peritoneal membrane solute transfer characteristics (PMTC) in long-term peritoneal dialysis (PD) patients. METHODS This is a retrospective, single-center study including the follow-up of maintenance PD patients. According to the changes in PMTC from baseline to the last visit, patients were divided into three groups; stable (n = 11), increased (n = 41), and decreased transporters (n = 35). RESULTS Left atrium (LA) and Right ventricle (RV) dilatation were more prominent in the PMTC-decreased group compared to PMTC-increased and stable groups (p < 0.001 and p = 0.07, respectively). The Cox regression analysis showed that only decreased PMTC was associated with LA dilatation (HR 2.89 [CI 95%1.54, 5.45] p < 0.01) and RV dilatation (HR 3.01 [CI 95%1.40, 6.21] p < 0.01). CONCLUSION PD can be associated with unfavorable dynamic changes in cardiac structure and functions even at the subclinical level.
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Affiliation(s)
- Mehmet Ası Oktan
- Dokuz Eylul University Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Izmir, Turkey
| | - Berfu Korucu
- Dokuz Eylul University Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Izmir, Turkey
| | - Ayşe Çolak
- Department of Cardiology, Dokuz Eylül University School of Medicine, Izmir, Turkey
| | - Yelda Deligöz Bildacı
- Dokuz Eylul University Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Izmir, Turkey
| | - Caner Çavdar
- Dokuz Eylul University Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Izmir, Turkey
| | - Serpil Müge Değer
- Dokuz Eylul University Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Izmir, Turkey
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Dörr K, Reindl-Schwaighofer R, Lorenz M, Marculescu R, Beitzke D, Hödlmoser S. Etelcalcetide Inhibits the Progression of Left Atrial Volume Index Compared to Alfacalcidol in Hemodialysis Patients. Cardiorenal Med 2023; 13:332-341. [PMID: 37729887 PMCID: PMC10664324 DOI: 10.1159/000533899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/03/2023] [Indexed: 09/22/2023] Open
Abstract
INTRODUCTION Increased left atrial (LA) size is a risk factor for cardiovascular events and all-cause mortality. It is closely related to left ventricular hypertrophy and chronic volume overload, both of which are common in hemodialysis. Calcimimetic treatment with etelcalcetide (ETL) previously showed an inhibitory effect on left ventricular mass index (LVMI) progression in this population. METHODS This is a post hoc analysis of the EtECAR-HD trial, where 62 patients were randomized to ETL or alfacalcidol (ALFA) for 1 year. LA volume index (LAVI) was measured using cardiac magnetic resonance imaging. The aim of the study was to investigate whether ETL was associated with a change of LAVI. RESULTS Median baseline levels of LAVI were 40 mL/m2 (31, 54 IQR) in the ETL group and 36 mL/m2 (26, 46 IQR) in the ALFA group. In the ITT population, the change of LAVI was 5.0 mL/m2 [95% CI: -0.04, 10] lower under ETL, compared to ALFA (p = 0.052, R2adj = 0.259). In the PP population, the difference in LAVI changes widened to 5.8 [95% CI: 0.36, 11], p = 0.037, R2adj = 0.302). Secondary analysis showed that the study delta of LVMI was correlated with the LAVI delta (r = 0.387) and that an inclusion of LVMI delta in the ANCOVA model mediated the effect on LAVI delta to β = 3.3 [95% CI: -0.04, 10] (p = 0.2, R2adj = 0.323). The same could not be observed for parameters assessing the volume status. CONCLUSIONS The analysis indicates that ETL could inhibit LAVI progression compared with ALFA. This effect was mediated by the change of LVMI.
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Affiliation(s)
- Katharina Dörr
- Department of Nephrology, Medical University of Vienna, Vienna, Austria
| | | | | | - Rodrig Marculescu
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Dietrich Beitzke
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Vienna, Austria
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O'Driscoll JM, Edwards JJ, Greenhough E, Smith E, May M, Gupta S, Marciniak A, Sharma R. The value of cardiopulmonary exercise testing and stress echocardiography in the prediction of all-cause mortality in adults with end-stage renal disease. Eur J Sport Sci 2023:1-10. [PMID: 36815759 DOI: 10.1080/17461391.2023.2184727] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
We aimed to assess the prognostic utility of different parameters routinely assessed from cardiopulmonary exercise testing (CPET) and exercise echocardiography in adults with end-stage renal disease (ESRD). Forty-two ESRD (37 male) individuals (age: 58 ± 13 years, height: 169.30 ± 8.30 cm, weight: 81 ± 15 kg, body surface area: 1.92 ± 0.20 m2) underwent a maximal/symptom limited CPET, with a full cross-sectional echocardiogram performed at baseline and peak exercise. All participants were prospectively followed over a 10-year period, with all-cause mortality as the primary endpoint. After the follow-up period, a total of 19 participants (45%) died. Left atrial size (4.70 ± 0.70 vs. 3.65 ± 0.50 cm, P < 0.001) and anteroseptal wall thickness (1.28 ± 0.40 vs. 1.06 ± 0.02 cm, P = 0.002) were significantly greater in those that died, while peak heart rate was significantly lower (108 ± 12 vs. 128 ± 14 bpm, P < 0.001). The prevalence of myocardial ischaemia (13 vs. 8 participants, P = 0.03) was significantly greater, while peak VO2 (9.80 ± 2.10 vs. 15.90 ± 4.30 ml·kg-1·min-1, P < 0.001) was significantly lower in those that died. Following multivariate cox regression, myocardial ischaemia (Hazard Ratio 3.08; 95% Confidence Interval 1.09-8.70; P = 0.03) and peak VO2 (HR 0.73; 95% CI 0.64-0.84; P < 0.001) were significant independent predictors of 10-year all-cause mortality. This is the first study to establish peak VO2 as powerful marker of all-cause mortality when assessed with clinical, resting and stress echocardiography parameters in people with ESRD over a 10-year follow up period. This observation indicates that, in clinical practice, CPET and exercise echocardiography may serve as valuable tools for the risk stratification of individuals with ESRD. HIGHLIGHTSWe aimed to assess the prognostic utility of cardiopulmonary exercise testing (CPET) and exercise echocardiography in end-stage renal disease (ESRD) with 10-year mortality.Peak aerobic capacity and the presence of ischaemic heart disease were independently associated with all-cause mortality.This observation indicates that, in clinical practice, CPET and exercise echocardiography may serve as valuable tools for the risk stratification of individuals with end-stage renal disease.
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Affiliation(s)
- J M O'Driscoll
- Department of Cardiology, St George's Healthcare NHS Trust, London, UK.,School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, UK
| | - J J Edwards
- School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, UK
| | - E Greenhough
- Department of Cardiology, St George's Healthcare NHS Trust, London, UK
| | - E Smith
- Department of Cardiology, St George's Healthcare NHS Trust, London, UK
| | - M May
- Department of Cardiology, St George's Healthcare NHS Trust, London, UK
| | - S Gupta
- York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
| | - A Marciniak
- Department of Cardiology, St George's Healthcare NHS Trust, London, UK
| | - R Sharma
- Department of Cardiology, St George's Healthcare NHS Trust, London, UK
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Meucci MC, Reinders MEJ, Groeneweg KE, Bezstarosti S, Marsan NA, Bax JJ, De Fijter JW, Delgado V. Left Atrial Structural and Functional Response in Kidney Transplant Recipients Treated With Mesenchymal Stromal Cell Therapy and Early Tacrolimus Withdrawal. J Am Soc Echocardiogr 2023; 36:172-179. [PMID: 36347387 DOI: 10.1016/j.echo.2022.10.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 10/09/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Autologous bone marrow-derived mesenchymal stromal cell (MSC) therapy and withdrawal of calcineurin inhibitors (CNIs) has been shown to improve systemic blood pressure control and left ventricular hypertrophy regression in kidney transplant recipients. In the current subanalysis, we aimed to evaluate the impact of this novel immunosuppressive regimen on the longitudinal changes of left atrial (LA) structure and function after kidney transplantation. METHODS Kidney transplant recipients randomized to MSC therapy-infused at weeks 6 and 7 after transplantation, with complete discontinuation at week 8 of tacrolimus (MSC group)-or standard tacrolimus dose (control group) were evaluated with transthoracic echocardiography at weeks 4 and 24 after kidney transplantation. The changes in echocardiographic parameters were compared between the randomization arms using an analysis of covariance model adjusted for baseline variable. RESULTS Fifty-four participants (MSC therapy = 27; tacrolimus therapy = 27) were included. There was no significant interaction between the allocated treatment and the changes of indexed maximal LA volume (LAVImax) over the study period. Conversely, between 4 and 24 weeks post-transplantation, an increase in indexed minimal LA volume (LAVImin) was observed in control subjects, while it remained unchanged in the MSC group, leading to a significant difference between groups (P = .021). Additionally, patients treated with MSC therapy showed a benefit in LA function, assessed by a significant interaction between changes in LA emptying fraction and LA reservoir strain and the randomization arm (P = .012 and P = .027, respectively). CONCLUSIONS The combination of MSC therapy and CNIs withdrawal prevents progressive LA dilation and dysfunction in the first 6 months after kidney transplantation. LAVImin and LA reservoir strain may be more sensitive markers of LA reverse remodeling, compared with LAVImax.
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Affiliation(s)
- Maria Chiara Meucci
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marlies E J Reinders
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands; Erasmus MC Transplant Institute, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Koen E Groeneweg
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Suzanne Bezstarosti
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands; Department of Immunology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Heart Center, University of Turku and Turku University Hospital, Turku, Finland
| | - Johan W De Fijter
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Hospital University Germans Trias i Pujol, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain.
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Wang Y, Huang G, Ma X, Zang X, Bai S, Wang Y, Du L, Lv Z, Li J, Chen H, Hu Y, Shi Y, Zhou X, Tao M, Zhuang S, Liu N. A retrospective study of baseline peritoneal transport character and left ventricular hypertrophy in incident peritoneal dialysis patients: interrelationship and prognostic impacts. Ren Fail 2022; 44:2073-2084. [PMID: 36645038 PMCID: PMC9848238 DOI: 10.1080/0886022x.2022.2148536] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Left ventricular hypertrophy is associated with adverse outcomes among peritoneal dialysis patients. The aim of this study was to evaluate the prognostic impact of baseline left ventricular hypertrophy and its relationship with baseline peritoneal transfer characteristics in peritoneal dialysis patients. METHODS We enrolled 151 incident peritoneal dialysis patients to perform a multicentric retrospective cohort study since January 1, 2017 to January 31, 2021. Patients were grouped based on baseline dialysate-to-plasma creatinine ratio at 4 h as follows: low (<0.50), low average (0.5-0.64), high average (0.65-0.80) and high (≥0.81). Echocardiography and clinic data were recorded yearly. The Cox proportional hazards models and competing risk model were used to evaluate patients' survival. Generalized linear mixed models were performed to explore risk factors associated with left ventricular hypertrophy. RESULTS During a median follow-up period of 33 months (range, 16-48 months), 21 (13.9%) patients died, including 16 (10.60%) cardiovascular deaths. Controlling the competing risks of switching to hemodialysis, kidney transplantation and loss to follow-up, baseline left ventricular hypertrophy was an independent risk factor for all-cause mortality (subdistribution hazard ratio, 2.645; 95% confidence interval, 1.156-6.056; p = 0.021). Baseline high and high average transport status were positively related to left ventricular mass index and left atrium diameter 2 years after PD initiation. CONCLUSION Baseline fast peritoneal solute transport rate may be an effect factor for aggravating left ventricular hypertrophy which predicted poor outcomes for peritoneal dialysis patients. The findings offered important ideas for further prospective intervention study.
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Affiliation(s)
- Yi Wang
- Department of Nephrology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Guansen Huang
- Department of Nephrology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaoyan Ma
- Department of Nephrology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiujuan Zang
- Department of Nephrology, Shanghai Songjiang District Central Hospital, Shanghai, China
| | - Shoujun Bai
- Department of Nephrology, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Yakun Wang
- Department of Nephrology, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Lin Du
- Department of Nephrology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zexin Lv
- Department of Nephrology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jinqing Li
- Department of Nephrology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hui Chen
- Department of Nephrology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yan Hu
- Department of Nephrology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yingfeng Shi
- Department of Nephrology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xun Zhou
- Department of Nephrology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Min Tao
- Department of Nephrology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shougang Zhuang
- Department of Nephrology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China,Department of Medicine, Rhode Island Hospital and Alpert Medical School, Brown University, Providence, RI, USA
| | - Na Liu
- Department of Nephrology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China,CONTACT Na Liu Department of Nephrology, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo road, Pudong new district, Shanghai, 200120, China
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Molnár AÁ, Merkely B. The Added Value of Atrial Strain Assessment in Clinical Practice. Diagnostics (Basel) 2022; 12:diagnostics12040982. [PMID: 35454030 PMCID: PMC9025202 DOI: 10.3390/diagnostics12040982] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/05/2022] [Accepted: 04/12/2022] [Indexed: 12/28/2022] Open
Abstract
Speckle tracking echocardiography has emerged as a sensitive tool to analyze myocardial function with improved diagnostic accuracy and prognostic value. Left atrial strain assessment has become a novel imaging method in cardiology with superior prognostic value compared to conventional left atrial volume indices. Left atrial function is divided into three phases, reservoir function being the most important. This review summarizes the added value of speckle tracking echocardiography derived left atrial strain assessment in clinical practice. Recently published data suggest the prognostic value of left atrial reservoir function in heart failure, atrial fibrillation, stroke and valvular heart disease. Furthermore, left atrial reservoir strain proved to be a predictor of cardiovascular morbidity and mortality in the general population. Thus, routine assessment of left atrial function can be an optimal strategy to improve cardiovascular risk prediction and supplement the current risk prediction models.
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Bai J, Zhang X, Zhang A, Zhang Y, Ren K, Ren Z, Zhao C, Wang Q, Cao N. Cardiac valve calcification is associated with mortality in hemodialysis patients: a retrospective cohort study. BMC Nephrol 2022; 23:43. [PMID: 35065601 PMCID: PMC8783521 DOI: 10.1186/s12882-022-02670-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 01/12/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Cardiac valve calcification (CVC) is common in end-stage renal disease (ESRD). We investigated the effect of CVC on all-cause and cardiovascular (CV) mortality in maintenance hemodialysis (MHD) patients.
Methods
A retrospective cohort study was conducted on 434 hemodialysis patients who underwent echocardiography for qualitative assessment of valve calcification with complete follow-up data from January 1, 2014, to April 30, 2021. The baseline data between the CVC and non-CVC groups were compared. The Kaplan–Meier method was used to analyse all-cause and cardiovascular mortality. The association of CVC with all-cause and cardiovascular mortality was evaluated using multivariate Cox regression analysis.
Results
Overall, 27.2% of patients had mitral valve calcification (MVC), and 31.8% had aortic valve calcification (AVC) on echocardiography. Patients with CVC showed significantly higher all-cause (log-rank P < 0.001) and cardiovascular (log-rank P < 0.001) mortality rates than patients without CVC. In multivariate regression analyses, MVC (HR: 1.517, P = 0.010) and AVC (HR: 1.433, P = 0.028) were significant factors associated with all-cause mortality. MVC (HR: 2.340, P < 0.001) and AVC (HR: 2.410, P < 0.001) were also significant factors associated with cardiovascular mortality.
Conclusions
MVC and AVC increased the risk of all-cause and cardiovascular mortality in MHD patients. Regular follow-up with echocardiography could be a useful method for risk stratification in MHD patients.
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Prevalence and renal prognosis of left ventricular diastolic dysfunction in non-dialysis chronic kidney disease patients with preserved systolic function. J Hypertens 2021; 40:723-731. [DOI: 10.1097/hjh.0000000000003069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Roumeliotis A, Roumeliotis S, Chan C, Pierratos A. Cardiovascular Benefits of Extended-Time Nocturnal Hemodialysis. Curr Vasc Pharmacol 2021; 19:21-33. [PMID: 32234001 DOI: 10.2174/1570161118666200401112106] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 03/10/2020] [Accepted: 03/11/2020] [Indexed: 01/09/2023]
Abstract
Hemodialysis (HD) remains the most utilized treatment for End-Stage Kidney Disease (ESKD) globally, mainly as conventional HD administered in 4 h sessions thrice weekly. Despite advances in HD delivery, patients with ESKD carry a heavy cardiovascular morbidity and mortality burden. This is associated with cardiac remodeling, left ventricular hypertrophy (LVH), myocardial stunning, hypertension, decreased heart rate variability, sleep apnea, coronary calcification and endothelial dysfunction. Therefore, intensive HD regimens closer to renal physiology were developed. They include longer, more frequent dialysis or both. Among them, Nocturnal Hemodialysis (NHD), carried out at night while asleep, provides efficient dialysis without excessive interference with daily activities. This regimen is closer to the physiology of the native kidneys. By providing increased clearance of small and middle molecular weight molecules, NHD can ameliorate uremic symptoms, control hyperphosphatemia and improve quality of life by allowing a liberal diet and free time during the day. Lastly, it improves reproductive biology leading to successful pregnancies. Conversion from conventional to NHD is followed by improved blood pressure control with fewer medications, regression of LVH, improved LV function, improved sleep apnea, and stabilization of coronary calcifications. These beneficial effects have been associated, among others, with better extracellular fluid volume control, improved endothelial- dependent vasodilation, decreased total peripheral resistance, decreased plasma norepinephrine levels and restoration of heart rate variability. Some of these effects represent improvements in outcomes used as surrogates of hard outcomes related to cardiovascular morbidity and mortality. In this review, we consider the cardiovascular effects of NHD.
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Affiliation(s)
- Athanasios Roumeliotis
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stefanos Roumeliotis
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christopher Chan
- University Health Network, Toronto General Hospital, Toronto, Canada
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Martínez Fernández L, Sánchez-Alvarez JE, Morís de la Tassa C, Bande Fernández JJ, María V, Fernández E, Valdivielso JM, Betriu A. Risk factors associated with valvular calcification in patients with chronic kidney disease. Analysis of NEFRONA study. Nefrologia 2021; 41:337-346. [PMID: 36166249 DOI: 10.1016/j.nefroe.2021.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 08/14/2020] [Indexed: 06/16/2023] Open
Abstract
INTRODUCTION Patients with chronic kidney disease (CKD) are at high risk of cardiovascular morbidity and mortality. Subclinical cardiac structural alterations have prognostic value in these patients. The aim was to analyse the prevalence of valvular calcification, the evolution and the relationship with different risk factors. MATERIAL AND METHODS Part of the sample of the NEFRONA study was randomly selected. Aortic and mitral valve calcification were analysed in echocardiograms performed at the baseline visit and at 24 months. RESULTS We included 397 patients, the estimated basal glomerular filtrate (eGFR) was 33 ml/min with significant decrease to 30.9 ml/min. There was an increase in the area of carotid and femoral plaque, as well as an increase in patients with aortic and mitral calcification at 24 months. A positive association of mitral calcification at 24 months with age, ankle-brachial index (ABI) and calcium-phosphorus product (CaxP) at baseline visit was observed, without association with eGFR. Aortic calcification at 24 months was positively associated with age, phosphorous and total carotid plaque area at baseline, with no relationship to eGFR. CONCLUSIONS A significant prevalence of valvular calcification was observed in patients with CKD without known cardiovascular disease.Two-year progression was observed independently of the eGFR. Patients with higher risk of mitral valve calcification were those with older age, higher ABI and CaxP product. Patients with a higher risk of aortic calcification were those with older age, higher phosphorous levels and larger area of carotid plaque. Identifying these higher risk patients would help to avoid future cardiovascular events intensifying follow-ups.
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Affiliation(s)
| | - J Emilio Sánchez-Alvarez
- Hospital Universitario de Cabueñes, Gijón, Asturias, Spain; Red de Investigación Renal (REDINREN), Spain
| | | | | | - Virtudes María
- Vascular and Renal Translational, Research Group, Institut de Recerca Biomèdica, Lleida, Spain
| | - Elvira Fernández
- Vascular and Renal Translational, Research Group, Institut de Recerca Biomèdica, Lleida, Spain
| | - Jose M Valdivielso
- Vascular and Renal Translational, Research Group, Institut de Recerca Biomèdica, Lleida, Spain
| | - Angels Betriu
- Vascular and Renal Translational, Research Group, Institut de Recerca Biomèdica, Lleida, Spain
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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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13
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Tanasa A, Burlacu A, Popa C, Kanbay M, Brinza C, Macovei L, Crisan-Dabija R, Covic A. A Systematic Review on the Correlations between Left Atrial Strain and Cardiovascular Outcomes in Chronic Kidney Disease Patients. Diagnostics (Basel) 2021; 11:diagnostics11040671. [PMID: 33917937 PMCID: PMC8068338 DOI: 10.3390/diagnostics11040671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/05/2021] [Accepted: 04/07/2021] [Indexed: 01/11/2023] Open
Abstract
Left atrial strain (LASr) represents a relatively new but promising technique for left atrial and left ventricle function evaluation. LASr was strongly linked to myocardial fibrosis and endocardial thickness, suggesting the utility of LASr in subclinical cardiac dysfunction detection. As CKD negatively impacts cardiovascular risk and mortality, underlying structural and functional abnormalities of cardiac remodeling are widely investigated. LASr could be used in LV diastolic dysfunction grading with an excellent discriminatory power. Our objectives were to assess the impact and existing correlations between LASr and cardiovascular outcomes, as reported in clinical trials, including patients with CKD. We searched PubMed, Web of Science, Embase, and the Cochrane Central Register of Controlled Trials for full-text papers. As reported in clinical studies, LASr was associated with adverse cardiovascular outcomes, including cardiovascular death and major adverse cardiovascular events (HR 0.89, 95% CI, 0.84–0.93, p < 0.01), paroxysmal atrial fibrillation (OR 0.847, 95% CI, 0.760–0.944, p = 0.003), reduced exercise capacity (AUC 0.83, 95% CI, 0.78–0.88, p < 0.01), diastolic dysfunction (p < 0.05), and estimated pulmonary capillary wedge pressure (p < 0.001). Despite limitations attributed to LA deformation imaging (image quality, inter-observer variability, software necessity, learning curve), LASr constitutes a promising marker for cardiovascular events prediction and risk evaluation in patients with CKD.
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Affiliation(s)
- Ana Tanasa
- Nephrology Clinic, Dialysis, and Renal Transplant Center—‘C.I. Parhon’ University Hospital, 700503 Iasi, Romania; (A.T.); (C.P.); (A.C.)
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (C.B.); (L.M.); (R.C.-D.)
| | - Alexandru Burlacu
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (C.B.); (L.M.); (R.C.-D.)
- Institute of Cardiovascular Diseases “Prof. Dr. George I.M. Georgescu”, 700503 Iasi, Romania
- Correspondence: ; Tel.: +40-744-488-580
| | - Cristina Popa
- Nephrology Clinic, Dialysis, and Renal Transplant Center—‘C.I. Parhon’ University Hospital, 700503 Iasi, Romania; (A.T.); (C.P.); (A.C.)
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (C.B.); (L.M.); (R.C.-D.)
| | - Mehmet Kanbay
- Department of Medicine, Division of Nephrology, Koc University School of Medicine, 34450 Istanbul, Turkey;
| | - Crischentian Brinza
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (C.B.); (L.M.); (R.C.-D.)
- Institute of Cardiovascular Diseases “Prof. Dr. George I.M. Georgescu”, 700503 Iasi, Romania
| | - Liviu Macovei
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (C.B.); (L.M.); (R.C.-D.)
| | - Radu Crisan-Dabija
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (C.B.); (L.M.); (R.C.-D.)
| | - Adrian Covic
- Nephrology Clinic, Dialysis, and Renal Transplant Center—‘C.I. Parhon’ University Hospital, 700503 Iasi, Romania; (A.T.); (C.P.); (A.C.)
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania; (C.B.); (L.M.); (R.C.-D.)
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14
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Nardi E, Mulè G, Giammanco A, Mattina A, Geraci G, Nardi C, Averna M. Left ventricular hypertrophy in chronic kidney disease: A diagnostic criteria comparison. Nutr Metab Cardiovasc Dis 2021; 31:137-144. [PMID: 33092976 DOI: 10.1016/j.numecd.2020.08.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND AIMS CKD patients have a high prevalence of LVH and this leads to an increase of cardiovascular risk. The aim of this study was to assess the prevalence of left ventricular hypertrophy (LVH) and left ventricular geometry in a group of 293 hypertensive patients with stage 2-5 chronic kidney disease (CKD), compared with 289 essential hypertensive patients with normal renal function. METHODS AND RESULTS All patients underwent echocardiographic examination. Patients on stage 1 CKD, dialysis treatment, or with cardiovascular diseases were excluded. LVH was observed in 62.8% of patients with CKD and in 51.9% of essential hypertensive patients (P < 0.0001). We found increasingly higher left ventricular diameters, thicknesses, and mass from stage 2-5 CKD. Distribution of concentric and eccentric LVH was not very different between the two groups. However, after introducing mixed hypertrophy, the difference between the two groups group was disclosed (P = 0.027). Multiple regression analysis confirmed that the association between renal function and left ventricular mass (β -0.287; P < 0.0001) was independent by potential confounders. Diastolic function was significantly worse in patients with CKD, especially in more advanced stages. CONCLUSION Our study confirms that LVH is highly prevalent in patients with CKD, especially by using the most recent cut off; in this population, LVH is often characterized by the simultaneous increase of wall thicknesses and diameters with negative effects on diastolic function.
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Affiliation(s)
- Emilio Nardi
- Dipartimento di Promozione Della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE), Università Degli Studi di Palermo, Italy.
| | - Giuseppe Mulè
- Dipartimento di Promozione Della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE), Università Degli Studi di Palermo, Italy
| | - Antonina Giammanco
- Dipartimento di Promozione Della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE), Università Degli Studi di Palermo, Italy
| | - Alessandro Mattina
- Dipartimento di Promozione Della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE), Università Degli Studi di Palermo, Italy; Diabetes and Islet Transplantation Unit, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), UPMC, Palermo, Italy
| | - Giulio Geraci
- Dipartimento di Promozione Della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE), Università Degli Studi di Palermo, Italy; University of Palermo - Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties, Unit of Nephrology and Hypertension, Palermo, Italy
| | - Chiara Nardi
- Dipartimento di Promozione Della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE), Università Degli Studi di Palermo, Italy
| | - Maurizio Averna
- Dipartimento di Promozione Della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE), Università Degli Studi di Palermo, Italy
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15
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Martínez Fernández L, Sánchez-Alvarez JE, Morís de la Tassa C, Bande Fernández JJ, María V, Fernández E, Valdivielso JM, Betriu A. [Risk factors associated with valvular calcification in patients with chronic kidney disease. Analysis of NEFRONA Study]. Nefrologia 2020; 41:337-346. [PMID: 33358625 DOI: 10.1016/j.nefro.2020.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 08/04/2020] [Accepted: 08/14/2020] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Patients with chronic kidney disease (CKD) are at high risk of cardiovascular morbidity and mortality. Subclinical cardiac structural alterations have prognostic value in these patients. The aim was to analyse the prevalence of valvular calcification, the evolution and the relationship with different risk factors. MATERIAL AND METHODS Part of the sample of the NEFRONA study was randomly selected. Aortic and mitral valve calcification were analysed in echocardiograms performed at the baseline visit and at 24 months. RESULTS We included 397 patients, the estimated basal glomerular filtrate (eGFR) was 33ml/min with significant decrease to 30.9ml/min. There was an increase in the area of carotid and femoral plaque, as well as an increase in patients with aortic and mitral calcification at 24 months. A positive association of mitral calcification at 24 months with age, ankle-brachial index (ABI) and calcium-phosphorus product (CaxP) at baseline visit was observed, without association with eGFR. Aortic calcification at 24 months was positively associated with age, phosphorous and total carotid plaque area at baseline, with no relationship to eGFR. CONCLUSIONS A significant prevalence of valvular calcification was observed in patients with CKD without known cardiovascular disease.Two-year progression was observed independently of the eGFR. Patients with higher risk of mitral valve calcification were those with older age, higher ABI and CaxP product. Patients with a higher risk of aortic calcification were those with older age, higher phosphorous levels and larger area of carotid plaque. Identifying these higher risk patients would help to avoid future cardiovascular events intensifying follow-ups.
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Affiliation(s)
| | - J Emilio Sánchez-Alvarez
- Hospital Universitario de Cabueñes, Gijón, Asturias, España; Red de Investigación Renal (REDINREN), España
| | | | | | - Virtudes María
- Vascular and Renal Translational, Research Group, Institut de Recerca Biomèdica, Lleida, España
| | - Elvira Fernández
- Vascular and Renal Translational, Research Group, Institut de Recerca Biomèdica, Lleida, España
| | - José M Valdivielso
- Vascular and Renal Translational, Research Group, Institut de Recerca Biomèdica, Lleida, España
| | - Angels Betriu
- Vascular and Renal Translational, Research Group, Institut de Recerca Biomèdica, Lleida, España
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16
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Evaluation of left atrial remodeling in kidney transplant patients using cardiac magnetic resonance imaging. J Nephrol 2020; 34:851-859. [PMID: 32910428 DOI: 10.1007/s40620-020-00853-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/28/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Increased left atrial (LA) size predicts cardiovascular events in patients with end-stage kidney disease. There is a paucity of data on LA changes after kidney transplantation (KT). Accordingly, we used cardiac magnetic resonance imaging (CMR) to evaluate LA remodeling after KT, and examined its relationship with left ventricular (LV) measurements, blood pressure and cardiac biomarkers. METHODS In this prospective multi-center cohort study, 39 pre-transplant dialysis patients underwent KT and 42 eligible transplant recipients remained on dialysis. CMR, blood pressure and serum measurements for N-terminal pro b-type natriuretic peptide (NT-proBNP), high sensitivity C-reactive protein (hsCRP), and growth differentiation factor-15 (GDF-15) were performed at baseline and 12 months. RESULTS After 12 months, there were no significant changes in LA end-systolic volume index, LA end-diastolic volume index, or LA ejection fraction (LAEF) within the KT or dialysis group; changes over time did not differ between the 2 groups (all p > 0.25). At baseline and over 12 months, LA volumes and LAEF positively correlated with LV volumes and mass while LAEF positively correlated with LV function. Changes in LA volumes also positively correlated with NT-proBNP and systolic blood pressure (sBP) while LAEF negatively correlated with NT-proBNP. GDF-15 correlated with LA measurements at baseline but not in 12-month changes. hsCRP did not correlate with any LA measurements. CONCLUSIONS LA volumes and function as measured by CMR did not change significantly over 12 months post-KT. There were significant associations between LA and LV remodeling, NT-proBNP and sBP, suggesting common underlying pathophysiological mechanisms.
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17
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Upstroke Time as a Novel Predictor of Mortality in Patients with Chronic Kidney Disease. Diagnostics (Basel) 2020; 10:diagnostics10060422. [PMID: 32575766 PMCID: PMC7345458 DOI: 10.3390/diagnostics10060422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/17/2020] [Accepted: 06/18/2020] [Indexed: 02/07/2023] Open
Abstract
Upstroke time (UT), measured from the foot-to-peak peripheral pulse wave, is a merged parameter used to assess arterial stiffness and target vascular injuries. In this study, we aimed to investigate UT for the prediction of cardiovascular and all-cause mortality in patients with chronic kidney disease (CKD). This longitudinal study enrolled 472 patients with CKD. Blood pressure, brachial pulse wave velocity (baPWV), and UT were automatically measured by a Colin VP-1000 instrument. During a median follow-up of 91 months, 73 cardiovascular and 183 all-cause mortality instances were recorded. Multivariable Cox analyses indicated that UT was significantly associated with cardiovascular mortality (hazard ratio (HR) = 1.010, p = 0.007) and all-cause mortality (HR = 1.009, p < 0.001). The addition of UT into the clinical models including traditional risk factors and baPWV further increased the value in predicting cardiovascular and all-cause mortality (both p < 0.001). In the Kaplan–Meier analyses, UT ≥ 180 ms could predict cardiovascular and all-cause mortality (both log-rank p < 0.001). Our study found that UT was a useful parameter in predicting cardiovascular and all-cause mortality in CKD patients. Additional consideration of the UT might provide an extra benefit in predicting cardiovascular and all-cause mortality beyond the traditional risk factors and baPWV.
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18
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Cryoballoon versus radiofrequency ablation for paroxysmal atrial fibrillation in hemodialysis patients. Heart Vessels 2020; 35:1709-1716. [PMID: 32524235 DOI: 10.1007/s00380-020-01646-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/05/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Little evidence exists regarding cryoballoon ablation (CBA) of paroxysmal atrial fibrillation (PAF) in hemodialysis (HD) patients. We compared CBA and radiofrequency ablation (RFA) of PAF in HD patients, referring to CBA of PAF in non-HD patients. METHODS AND RESULTS This historical cohort study examined 88 patients who underwent catheter ablation of PAF, including 21 HD patients with a second-generation 28-mm cryoballoon (CB-HD group), 17 HD patients with a non-force-sensing radiofrequency catheter (RF-HD group), and 50 non-HD patients with a cryoballoon (CB-non-HD group). Pulmonary vein (PV) isolation alone aside from cavotricuspid isthmus ablation was performed in 14 (67%) in the CB-HD group, 12 (71%) in the RF-HD group, and 36 (72%) in the CB-non-HD group (P = 0.95), without isoproterenol-induced non-PV triggers. Non-PV trigger ablation was added to the other patients. The Kaplan-Meier estimated 1-year freedom from atrial tachyarrhythmia recurrence without antiarrhythmic drugs after a single procedure was 76%, 59%, and, 92% in the CB-HD, RF-HD, and CB-non-HD groups, respectively (P = 0.002). The mean procedure time was shorter in the CB-HD group than in the RF-HD group (127 vs. 199 min; P < 0.001). In the second procedure, the median number of reconnected pulmonary veins was 0.5 in the CB-HD group versus 2.0 in the RF-HD group (P = 0.17). CONCLUSION For PAF in HD patients, CBA showed a comparable single-procedure efficacy to that of RFA with a short procedure time. CBA may be a reasonable initial procedure for HD patients suffering from symptomatic PAF.
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Dohi K. Echocardiographic assessment of cardiac structure and function in chronic renal disease. J Echocardiogr 2019; 17:115-122. [PMID: 31286437 DOI: 10.1007/s12574-019-00436-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 06/26/2019] [Accepted: 07/01/2019] [Indexed: 10/26/2022]
Abstract
Chronic kidney disease (CKD) is a global health problem and is independently associated with increased risk for cardiovascular disease (CVD). The presence and severity of CKD is strongly related to the progression of coronary atherosclerosis, ventricular hypertrophy, myocardial fibrosis, valvular calcification, and cardiac conduction system abnormalities. Echocardiography plays a major role in the assessment of structural and functional cardiac abnormalities in CKD including abnormal left-ventricular (LV) geometry, LV diastolic dysfunction, valvular disease, and left atrial dilatation, which are very frequently present especially in patients with end-stage renal disease.
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Affiliation(s)
- Kaoru Dohi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, 514-8507, Japan.
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20
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Ureche C, Sascău R, Țăpoi L, Covic A, Moroșanu C, Voroneanu L, Burlacu A, Stătescu C, Covic A. Multi-modality cardiac imaging in advanced chronic kidney disease. Echocardiography 2019; 36:1372-1380. [DOI: 10.1111/echo.14413] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 05/24/2019] [Accepted: 05/26/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
- Carina Ureche
- Cardiovascular Disease Institute; Iasi Romania
- ‘Grigore T. Popa’ University of Medicine; Iasi Romania
| | - Radu Sascău
- Cardiovascular Disease Institute; Iasi Romania
- ‘Grigore T. Popa’ University of Medicine; Iasi Romania
| | - Laura Țăpoi
- Cardiovascular Disease Institute; Iasi Romania
| | - Andreea Covic
- ‘Grigore T. Popa’ University of Medicine; Iasi Romania
| | | | - Luminița Voroneanu
- ‘Grigore T. Popa’ University of Medicine; Iasi Romania
- Nephrology Clinic, Dialysis and Renal Transplant Center - ‘C.I. Parhon’ University Hospital; Iasi Romania
| | - Alexandru Burlacu
- ‘Grigore T. Popa’ University of Medicine; Iasi Romania
- Department of Interventional Cardiology; Cardiovascular Diseases Institute; Iasi Romania
| | - Cristian Stătescu
- Cardiovascular Disease Institute; Iasi Romania
- ‘Grigore T. Popa’ University of Medicine; Iasi Romania
| | - Adrian Covic
- ‘Grigore T. Popa’ University of Medicine; Iasi Romania
- Nephrology Clinic, Dialysis and Renal Transplant Center - ‘C.I. Parhon’ University Hospital; Iasi Romania
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Li C, Zhang J, Fan R, Li W, Liu Y, Liu D, Lin H, Yao F, Ye M, He W. Left atrial strain associated with alterations in cardiac diastolic function in patients with end-stage renal disease. Int J Cardiovasc Imaging 2019; 35:1803-1810. [PMID: 31123845 DOI: 10.1007/s10554-019-01622-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 05/06/2019] [Indexed: 12/20/2022]
Abstract
The purpose of this study was to investigate the correlation between left atrial (LA) strain and alterations in cardiac diastolic function in patients with end-stage renal disease. 59 patients with stage 5 chronic kidney disease (CKD5) and 30 healthy controls were enrolled in this study. Patients with CKD5 were divided into three groups, from normal to Grade II diastolic dysfunction. LA longitudinal strain was evaluated using two-dimensional speckle tracking echocardiography. The peak LA longitudinal strain values (PALS) and LA stiffness index were recorded as the main parameters. Comparing with control group, index of LA volume (LAVI, 14.57 ± 6.92 vs. 20.15 ± 6.21 vs. 30.49 ± 10.66 vs. 42.99 ± 18.77) and index of left ventricular mass (LVMI, 77.64 ± 12.60 vs. 103.83 ± 15.90 vs. 155.01 ± 36.92 vs. 178.34 ± 44.47) significantly increased in CKD5 patients, along with the decline of diastolic function (p < 0.001). An incremental reduction in PALS (51.75 ± 5.82 vs. 40.23 ± 12.72 vs. 36.37 ± 8.59 vs. 33.33 ± 9.30, p < 0.001) as well as increase in LA stiffness index (0.11 ± 0.02 vs. 0.25 ± 0.10 vs. 0.38 ± 0.21 vs. 0.61 ± 0.51, p = 0.003) in apical 4 chamber (A4C) view and global value were observed in CKD5 patients, and higher LA stiffness index were shown in patients with Grade II diastolic dysfunction. What's more, estimated glomerular filtration rate was independently correlated with PALS-A4C (B = 0.084, 95% CI 0.002-0.166, p = 0.046), and LAVI adversely correlated with PALS-A4C (B = - 0.191, 95% CI - 0.379 to - 0.002), p = 0.047) and correlated with LA stiffness index in A4C (B = 0.011, 95% CI 0.006 -0.017, p < 0.001). In conclusion, LA longitudinal strain, combined with LAVI and LVMI, were independently associated with the decline in diastolic function in CKD5 patients, which might provide novel cardiovascular events predictors in these patients.
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Affiliation(s)
- Cuiling Li
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Er Road, Yuexiu District, Guangzhou, 510080, China
| | - Jingwei Zhang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Er Road, Yuexiu District, Guangzhou, 510080, China
| | - Rui Fan
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Er Road, Yuexiu District, Guangzhou, 510080, China
| | - Wei Li
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Er Road, Yuexiu District, Guangzhou, 510080, China
| | - Yanqiu Liu
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Er Road, Yuexiu District, Guangzhou, 510080, China
| | - Donghong Liu
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Er Road, Yuexiu District, Guangzhou, 510080, China
| | - Hong Lin
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Er Road, Yuexiu District, Guangzhou, 510080, China.
| | - Fengjuan Yao
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Er Road, Yuexiu District, Guangzhou, 510080, China
| | - Min Ye
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Er Road, Yuexiu District, Guangzhou, 510080, China
| | - Wei He
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Er Road, Yuexiu District, Guangzhou, 510080, China
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22
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Point-of-care ultrasound in end-stage kidney disease: beyond lung ultrasound. Curr Opin Nephrol Hypertens 2019; 27:487-496. [PMID: 30188387 DOI: 10.1097/mnh.0000000000000453] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Following the miniaturization of ultrasound devices, point-of-care ultrasound (POCUS) has been proposed as a tool to enhance the value of physical examination in various clinical settings. The objective of this review is to describe the potential applications of POCUS in end-stage renal disease patients (ESRD). RECENT FINDINGS With basic training, the clinician can perform pulmonary, vascular, cardiac, and abdominal POCUS at the bedside of ESRD patients. Pulmonary ultrasound can be used to quantify pulmonary congestion and for the differential diagnosis of dyspnea. Ultrasound of the inferior vena cava combined with simple cardiac ultrasound can be used to promptly investigate the mechanism of hemodynamic instability. Vascular ultrasound can be used for troubleshooting of arteriovenous fistula problems and for catheter installation. Multiple potential applications of POCUS in the ESRD population are reviewed, including areas of future research. SUMMARY Acquiring basic skills in POCUS may improve patient care through the rapid identification of threats, improved diagnostic abilities for common symptoms, and safer procedures. The adoption of POCUS in undergraduate, internal medicine and nephrology training curriculums will likely lead to a gradual introduction of this technology in the care of ESRD patients.
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Toida T, Toida R, Yamashita R, Komiya N, Uezono S, Komatsu H, Ishikawa T, Kitamura K, Sato Y, Fujimoto S. Grading of Left Ventricular Diastolic Dysfunction with Preserved Systolic Function by the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging Recommendations Contributes to Predicting Cardiovascular Events in Hemodialysis Patients. Cardiorenal Med 2019; 9:190-200. [PMID: 30844787 DOI: 10.1159/000496064] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 12/06/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Left ventricular diastolic dysfunction (LVDD) causes heart failure with a preserved left ventricular ejection fraction (LVEF) in the general population. OBJECTIVE To examine the relationships between the LVDD grades of the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging (ASE/EACVI) recommendations and several arteriosclerotic parameters and major cardiovascular events (MACE) in hemodialysis patients with preserved LVEF. METHOD Sixty-three prevalent hemodialysis patients (median age [interquartile range], 69 [64-75] years, 31.7% female) with normal systolic function (LVEF > 50%) were enrolled. LVDD evaluated by echocardiography at baseline was divided into three groups according to ASE/EACVI recommendations (normal diastolic function [ND], n = 24; intermediate, n = 19; diastolic dysfunction [DD], n = 20). All patients underwent analyses of several arteriosclerotic parameters (carotid intima-media thickness [CIMT], plaque score [PS], ankle brachial index [ABI], and brachial-ankle pulse wave velocity [baPWV]). The presence or absence of postdialysis orthostatic hypotension was assessed in each dialysis session. MACE during the 1-year follow-up period was obtained from medical records. Kaplan-Meier and Cox's regression analyses were used to investigate the relationship between LVDD grades and MACE. RESULTS Postdialysis orthostatic hypotension and PS, but not CIMT, ABI, or baPWV, increased proportionally with LVDD grades. Eleven patients developed MACE, including 2 cardiovascular deaths. The Kaplan-Meier analysis showed that MACE frequently occurred in the DD grade (p = 0.002 by the log-rank test). Cox's regression analysis adjusted for potential confounders (age, sex, diabetes, systolic blood pressure, and body mass index) revealed that the DD grade was associated with MACE when the ND grade was set as a reference. CONCLUSIONS In maintenance hemodialysis patients with normal ventricular systolic function, a classification of LVDD by the 2016 ASE/EACVI recommendations may be a useful tool for predicting cardiovascular events.
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Affiliation(s)
- Tatsunori Toida
- Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine, University of Miyazaki, Miyazaki City, Japan, .,Department of Internal Medicine, Miyazaki Prefectural Nobeoka Hospital, Nobeoka City, Japan,
| | - Reiko Toida
- Department of Cardiology, Chiyoda Hospital, Hyuga City, Japan
| | - Risa Yamashita
- Department of Internal Medicine, Miyazaki Prefectural Nobeoka Hospital, Nobeoka City, Japan
| | - Norihiro Komiya
- Department of Cardiology, Chiyoda Hospital, Hyuga City, Japan
| | | | - Hiroyuki Komatsu
- Division of Circulatory and Body Fluid Regulation, Department of Internal Medicine, University of Miyazaki, Miyazaki City, Japan
| | - Tetsunori Ishikawa
- Division of Circulatory and Body Fluid Regulation, Department of Internal Medicine, University of Miyazaki, Miyazaki City, Japan
| | - Kazuo Kitamura
- Division of Circulatory and Body Fluid Regulation, Department of Internal Medicine, University of Miyazaki, Miyazaki City, Japan
| | - Yuji Sato
- Dialysis Division, University of Miyazaki Hospital, Miyazaki City, Japan
| | - Shouichi Fujimoto
- Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine, University of Miyazaki, Miyazaki City, Japan.,Dialysis Division, University of Miyazaki Hospital, Miyazaki City, Japan
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Left Atrial Remodeling Assessed by Cardiac MRI after Conversion from Conventional Hemodialysis to In-Centre Nocturnal Hemodialysis. J Nephrol 2018; 32:273-281. [PMID: 30168083 DOI: 10.1007/s40620-018-0522-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 08/08/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND Left atrial (LA) volume is a well-established cardiovascular prognosticator in patients with end-stage renal disease. Although dialysis intensification is associated with left ventricular mass regression, there are limited data regarding LA remodeling. Using cardiac magnetic resonance imaging (CMR), we examined changes in LA size and function relative to ventricular remodeling and cardiac biomarkers after dialysis intensification. METHODS In this prospective 2-centre cohort study, 37 patients receiving conventional hemodialysis (CHD, 4 h/session, 3×/week) were converted to in-centre nocturnal hemodialysis (INHD 7-8 h/session, 3×/week); 30 patients remained on CHD. CMR and biomarkers were performed at baseline and repeated at 52 weeks. RESULTS After 52 weeks, there were no significant changes in the LA volumes or LA ejection fraction (EF) within either the CHD or INHD group, and no significant differences between the two groups. Correlations existed between changes in LA and LV end-diastolic volume index (EDVi, Spearman's r = 0.69, p < 0.001), LA and LV end-systolic volume index (ESVi, r = 0.44, p = 0.001), LAEF and LVEF (r = 0.28, p = 0.04), LA and RV EDVi (r = 0.51, p < 0.001), LA and RV ESVi (r = 0.29, p = 0.039), and LA ESVi and LV mass index (r = 0.31, p = 0.02). At baseline, indexed LA volumes positively correlated with NT-proBNP, whereas LAEF negatively correlated with NT-proBNP and Troponin I. After 52 weeks, changes in biomarker levels did not correlate with changes in LA volume or EF. CONCLUSION There was no significant change in LA size or systolic function after conversion to INHD. The significant correlations between LA and ventricular remodeling and cardiac biomarkers suggest common underlying pathophysiologic mechanisms. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT00718848.
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Yu JJ, Jun HO, Shin EJ, Baek JS, Lee JH, Kim YH, Park YS, Ko JK. Factors associated with reduction of left ventricular mass in children on peritoneal dialysis. Nephrology (Carlton) 2018; 23:338-344. [PMID: 28199756 DOI: 10.1111/nep.13033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 02/04/2017] [Accepted: 02/07/2017] [Indexed: 01/20/2023]
Abstract
AIM This study aimed to investigate sensitive factors involved in left ventricular mass reduction in children with end-stage renal disease (ESRD) undergoing peritoneal dialysis. METHODS Thirty-five subjects on peritoneal dialysis were enrolled. Two successive echocardiographic and clinical data for each subject were obtained. Blood pressure and left ventricular mass index (LVMI) were indexed through a division with the normal 95th percentile value. Differences in numeric data between two datasets were calculated. RESULTS The mean age was 12.9 ± 4.6 years. Predictors of left ventricular hypertrophy and its persistence were systolic blood pressure index (P = 0.019 and P = 0.046) and E' velocity (P = 0.035 and P = 0.031) in univariate analysis. However, differences in these predictors between the datasets were not related to the change in indexed LVMI. Reduction in indexed LVMI was correlated to a reduction of indexed left atrial volume (R = 0.638, P = 0.001), trans-mitral A velocity (R = 0.443, P = 0.011), and serum blood urea nitrogen level (R = 0.372, P = 0.028) and an elevation of haemoglobin level (R = -0.374, P = 0.027). CONCLUSION The extent of circulating volume expansion is potentially the main predictive factor for change of LVMI, because the volume dependent diastolic functional variables correlate to the change of LVMI. Further study with a large number of ESRD children including a group under fluid volume control is needed to investigate the role of volume expansion on the change of LVMI.
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Affiliation(s)
- Jeong Jin Yu
- Department of Pediatrics, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun Ok Jun
- Department of Pediatrics, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Jung Shin
- Department of Pediatrics, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Suk Baek
- Department of Pediatrics, University of Ulsan College of Medicine, Seoul, Korea
| | - Joo Hoon Lee
- Department of Pediatrics, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Hwue Kim
- Department of Pediatrics, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Seo Park
- Department of Pediatrics, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Kon Ko
- Department of Pediatrics, University of Ulsan College of Medicine, Seoul, Korea
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Matsushita K, Kwak L, Sang Y, Ballew SH, Skali H, Shah AM, Coresh J, Solomon S. Kidney Disease Measures and Left Ventricular Structure and Function: The Atherosclerosis Risk in Communities Study. J Am Heart Assoc 2017; 6:JAHA.117.006259. [PMID: 28939714 PMCID: PMC5634280 DOI: 10.1161/jaha.117.006259] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Heart failure is one of the most important complications of chronic kidney disease (CKD). However, few studies comprehensively investigated left ventricular (LV) structure and function in relation to 2 key CKD measures, estimated glomerular filtration rate (eGFR) and urine albumin/creatinine ratio (ACR). Methods and Results Among 4175 ARIC (Atherosclerosis Risk in Communities) participants (aged 66–90 years during 2011–2013), we quantified the association of eGFR and ACR with echocardiogram parameters of LV mass, size, systolic function, and diastolic function. Adjusting for demographic variables, both CKD measures were significantly associated with most echocardiogram parameters. Additionally accounting for other potential confounders, we observed significantly higher LV mass index according to reduced eGFR (82.3 [95% confidence interval (CI), 77.6–87.0] g/m2 for eGFR <30 mL/min per 1.73 m2, 80.9 [95% CI, 77.3–84.6] g/m2 for eGFR 30–44 mL/min per 1.73 m2, and 80.1 [95% CI, 76.7–83.5] g/m2 for eGFR 45–59 mL/min per 1.73 m2 compared with 78.7 [95% CI, 75.3–82.1] g/m2 for eGFR 75–89 mL/min per 1.73 m2; trend P<0.001). Regarding LV size and function, significant differences were observed for some parameters, particularly at eGFR <30 mL/min per 1.73 m2. For ACR, the associations remained significant for most parameters (eg, LV mass index, 91.5 [95% CI, 86.6–96.5] g/m2 for ACR ≥300 mg/g and 82.9 [95% CI, 79.4–86.3] g/m2 for ACR 30–299 mg/g compared with 77.7 [95% CI, 74.4–81.1] g/m2 for ACR <10 mg/g [trend P<0.001]; left arterial volume index, 24.9 [95% CI, 22.9–26.8] and 24.7 [95% CI, 23.4–26.1] mL/m2 compared with 23.4 [95% CI, 22.1–24.7] mL/m2, respectively [trend P=0.010]). Dichotomizing echo parameters with clinical thresholds, the stronger relationships of ACR over eGFR were further evident. Conclusions LV mass was related to both CKD measures, whereas LV size and function were robustly associated with albuminuria. These results have implications for pathophysiological processes behind cardiorenal syndrome and targeted cardiac assessment in patients with CKD.
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Affiliation(s)
- Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD .,Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD
| | - Lucia Kwak
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.,Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD
| | - Yingying Sang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.,Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD
| | - Shoshana H Ballew
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.,Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD
| | - Hicham Skali
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Amil M Shah
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.,Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD
| | - Scott Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Hwang JH, Park JB, Kim YJ, An JN, Yang J, Ahn C, Jung IM, Lim CS, Kim YS, Kim YH, Lee JP. The prognostic significance of preoperative left ventricular diastolic dysfunction and left atrial enlargement on acute coronary syndrome in kidney transplantation. Oncotarget 2017; 8:71154-71163. [PMID: 29050351 PMCID: PMC5642626 DOI: 10.18632/oncotarget.16862] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 03/28/2017] [Indexed: 01/15/2023] Open
Abstract
Echocardiography is commonly performed as a screening test to evaluate perioperative risks before kidney transplantation. However, only limited data are available on echocardiographic parameters of left ventricular diastolic dysfunction (LVDD) and left atrial enlargement (LAE) on acute coronary syndrome and mortality in kidney transplant recipients. We reviewed 2779 adult recipients who underwent pretransplant echocardiography from 1997 to 2012. We divided the patients into two and four groups by two categories: LVDD grades 0-1 vs. 2-3, and left atrial size quartile groups. During a mean follow-up of 4.5 years, acute coronary syndrome occurred in 89 (3.2%) patients. The recipients with LVDD grades 2-3 (P = 0.005 for non-fatal, P = 0.02 for fatal/non-fatal) and LAE (P = 0.001 for non-fatal, P = 0.03 for fatal/non-fatal) had a higher incidence of acute coronary syndrome after kidney transplantation. All-cause mortality did not differ significantly between the groups. In a multivariate analysis, LVDD of grades 2-3 (hazard ratio 2.98, 95% confidence interval 1.535-5.787; P = 0.001), and LAE (hazard ratio 1.052, 95% confidence interval 1.006-1.101; P = 0.03) were independently associated with non-fatal acute coronary syndrome. In patients who are kidney transplant candidates, pretransplant LVDD and LAE were independently associated with a higher incidence of acute coronary syndrome after kidney transplantation.
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Affiliation(s)
- Jin Ho Hwang
- Nephrology Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Jun-Bean Park
- Cardiology Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yong-Jin Kim
- Cardiology Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Nam An
- Nephrology Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
- Department of Critical Care Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jaeseok Yang
- Transplantation Center, Seoul National University Hospital, Seoul, Korea
| | - Curie Ahn
- Transplantation Center, Seoul National University Hospital, Seoul, Korea
- Nephrology Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - In Mok Jung
- Department of Surgery, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Chun Soo Lim
- Nephrology Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Yon Su Kim
- Nephrology Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Young Hoon Kim
- Department of Surgery, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Pyo Lee
- Nephrology Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
- Nephrology Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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The occurrence of atrial fibrillation in dialysis patients and its association with left atrium volume before and after dialysis. Int Urol Nephrol 2017; 49:1071-1077. [PMID: 28238149 DOI: 10.1007/s11255-017-1506-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 01/06/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE Atrial fibrillation is a serious problem, especially in patients on dialysis. The prevalence of AF in this group of patients is higher than in general population and associated with increased mortality. The aim of this study was to assess the risk of the occurrence of atrial fibrillation related to intradialysis hypotension and left atrium volume enlargement associated with dialysis. The influence of dialysis session on: E/E', V LA, E/A, E', V RA and the width of inferior vena cava of RV was analyzed. METHODS This study included 40 patients on hemodialysis. Echocardiographic examination was performed to assess heart condition and function, the presence of LVH and systolic and diastolic function disturbances, LV mass, LA size, LAV, RAV, E/A, E', E/E, ejection fraction in all patients before and after dialysis. Moreover, all patients had ECG Holter continuously recording heart's rhythm before and after dialysis to assess the occurrence of atrial fibrillation related to dialysis session. RESULTS The analysis of differences in echocardiographic parameters before and after dialysis demonstrated significantly greater left atrium volume, right atrium volume, width of inferior vena cava and e' parameter before dialysis in comparison with post-dialysis state. Significantly higher incidence of AF after dialysis was seen. Volume of left atrium exceeding 32 mm (cutoff value) was observed significantly more often in patients before dialysis. No association was observed between left ventricle mass and left atrium volume. CONCLUSIONS The dialysis procedure may be a trigger for atrial fibrillation and thus AF preventive measures should be introduced in dialysis patients.
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Kim JK, Song YR, Park G, Kim HJ, Kim SG. Impact of rapid ultrafiltration rate on changes in the echocardiographic left atrial volume index in patients undergoing haemodialysis: a longitudinal observational study. BMJ Open 2017; 7:e013990. [PMID: 28148536 PMCID: PMC5294025 DOI: 10.1136/bmjopen-2016-013990] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Optimal fluid management is essential when caring for a patient on haemodialysis (HD). However, if the fluid removal is too rapid, the resultant higher ultrafiltration rate (UFR) disadvantageously promotes haemodynamic instability and cardiac injury. We evaluated the effects of a rapid UFR on changes in the echocardiographic left atrial volume index (LAVI) over a period of time. DESIGN Longitudinal observational study. SETTING AND PARTICIPANTS A total of 124 new patients on HD. INTERVENTIONS Echocardiography was performed at baseline and repeated after 19.7 months (range 11.3-23.1 months). Changes in LAVI (ΔLAVI/year, mL/m2/year) were calculated. The UFR was expressed in mL/hour/kg, and we used the mean UFR over 30 days (∼12-13 treatments). MAIN OUTCOME MEASURES The 75th centile of the ΔLAVI/year distribution was regarded as a 'pathological' increment. RESULTS The mean interdialytic weight gain was 1.73±0.94 kg, and the UFR was 8.01±3.87 mL/hour/kg. The significant pathological increment point in ΔLAVI/year was 4.89 mL/m2/year. Correlation analysis showed that ΔLAVI/year was closely related to the baseline blood pressure, haemoglobin level, residual renal function and UFR. According to the receiver operating characteristics curve, the 'best' cut-off value of UFR for predicting the pathological increment was 10 mL/hour/kg, with an area under the curve of 0.712. In multivariate analysis, systolic blood pressure, a history of coronary artery disease, haemoglobin <10 g/dL and high UFR were significant predictors. An increase of 1 mL/hour/kg in the UFR was associated with a 22% higher risk of a worsening LAVI (OR 1.22, 95% CI 1.05 to 1.41). CONCLUSIONS An increased haemodynamic load could affect left atrial remodelling in incident patients on HD. Thus, close monitoring and optimal control of UFR are needed.
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Affiliation(s)
- Jwa-Kyung Kim
- Department of Internal Medicine and Kidney Research
Institute, Hallym University Sacred Heart Hospital,
Anyang, Korea
- Department of Clinical Immunology,
Hallym University Sacred Heart Hospital,
Anyang, Korea
| | - Young Rim Song
- Department of Internal Medicine and Kidney Research
Institute, Hallym University Sacred Heart Hospital,
Anyang, Korea
| | - GunHa Park
- Department of Internal Medicine and Kidney Research
Institute, Hallym University Sacred Heart Hospital,
Anyang, Korea
| | - Hyung Jik Kim
- Department of Internal Medicine and Kidney Research
Institute, Hallym University Sacred Heart Hospital,
Anyang, Korea
| | - Sung Gyun Kim
- Department of Internal Medicine and Kidney Research
Institute, Hallym University Sacred Heart Hospital,
Anyang, Korea
- Department of Clinical Immunology,
Hallym University Sacred Heart Hospital,
Anyang, Korea
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Kensinger C, Hernandez A, Bian A, Fairchild M, Chen G, Lipworth L, Ikizler TA, Birdwell KA. Longitudinal assessment of cardiac morphology and function following kidney transplantation. Clin Transplant 2017; 31:10.1111/ctr.12864. [PMID: 27801526 PMCID: PMC5215632 DOI: 10.1111/ctr.12864] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND Abnormal cardiac morphology is a risk factor for cardiovascular complications in kidney transplant patients. A supraphysiologic level of fibroblast growth factor 23 (FGF-23) has been associated with myocardial hypertrophy in this patient population. Our aim was to evaluate the change in cardiac morphology and function following kidney transplantation and to evaluate the association between the change in FGF-23 concentrations and cardiac morphology. METHODS We performed a longitudinal, prospective cohort study of 143 kidney transplant recipients (73% male, 75% white) measuring left ventricular (LV) mass index, left atrial (LA) volume index, and ejection fraction (EF) by echocardiography at months 1, 12, and 24 post-transplant. FGF-23 levels were measured at months 1 and 24 post-transplant. RESULTS Unadjusted and adjusted linear mixed-effects models were used to examine changes in outcomes over time. In the adjusted model, LV mass index (P<.001) and LA volume index (P<.001) decreased and EF (P=.009) increased significantly over time. There was a significant association between decreasing FGF-23 levels and improving LV mass index following transplant (P=.036) in the unadjusted model; however, there was no significant relationship in the adjusted model (0.195). CONCLUSION Understanding the progression of unique cardiovascular risk factors associated with kidney transplantation may provide potential opportunities to improve survival.
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Affiliation(s)
| | - Antonio Hernandez
- Department of Clinical Anesthesiology, Division of Critical Care Medicine and Cardiothoracic Anesthesiology
| | - Aihua Bian
- Department of Biostatistics, Vanderbilt University Medical Center
| | - Meagan Fairchild
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center
| | - Guanhua Chen
- Department of Biostatistics, Vanderbilt University Medical Center
| | - Loren Lipworth
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center
| | - T Alp Ikizler
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center
| | - Kelly A. Birdwell
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center
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Losi MA, Izzo R, Canciello G, Giamundo A, Manzi MV, Strisciuglio T, Stabile E, De Luca N, de Simone G, Trimarco B. Atrial Dilatation Development in Hypertensive Treated Patients: The Campania-Salute Network. Am J Hypertens 2016; 29:1077-84. [PMID: 27170030 DOI: 10.1093/ajh/hpw043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 04/08/2016] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Left atrial (LA) dilatation is associated with unfavorable outcome in hypertension. However, there are few data on clinical, demographic, and echocardiographic findings correlated with LA dilatation development. METHODS From the Campania-Salute Network registry, we identified 5,375 hypertensive patients (52±11 years, 38% women) in normal sinus rhythm, with normal LA diameter (parasternal short-axis <24.0 in women and <25.4mm/m in men), with normal left ventricular (LV) ejection fraction, and with at least 12 months of echocardiographic follow-up. We included in the clinic evaluation type of antihypertensive drugs. RESULTS Follow-up duration was of 70±48 months. During follow-up, 647 patients (12%) showed LA dilatation. Patients with incident LA dilatation were older, most likely to be women, more obese, more diabetics, with lower Modification of Diet in Renal Disease, higher total cholesterol, lower uric acid, higher pulse pressure, lower heart rate, higher LV mass, concentric geometry and lower E/A ratio at mitral level, longer E deceleration time, and higher intima-media carotid thickness. They take more drugs, and follow-up was longer (overall P < 0.05). In the Cox analysis, age, female gender, obesity, higher LV mass, LA diameter at baseline, and longer E deceleration time were determinants of LA dilatation. Furthermore, the use of diuretics protected against LA dilatation. CONCLUSIONS Our data identify a risk profile for LA dilatation, characterized by older age, female sex, obesity, higher LV mass, and worse diastolic function. In this subgroup of patients, the use of diuretics seems to protect against LA dilatation.
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Affiliation(s)
- Maria-Angela Losi
- Hypertension Research Center, University Federico II of Naples, Napoli, Italy; Department of Advanced Biomedical Sciences, University Federico II of Naples, Napoli, Italy
| | - Raffaele Izzo
- Hypertension Research Center, University Federico II of Naples, Napoli, Italy; Department of Translational Medicine, University Federico II of Naples, Napoli, Italy
| | - Grazia Canciello
- Hypertension Research Center, University Federico II of Naples, Napoli, Italy; Department of Advanced Biomedical Sciences, University Federico II of Naples, Napoli, Italy
| | - Alessandra Giamundo
- Hypertension Research Center, University Federico II of Naples, Napoli, Italy; Department of Advanced Biomedical Sciences, University Federico II of Naples, Napoli, Italy
| | - Maria V Manzi
- Hypertension Research Center, University Federico II of Naples, Napoli, Italy
| | - Teresa Strisciuglio
- Hypertension Research Center, University Federico II of Naples, Napoli, Italy; Department of Advanced Biomedical Sciences, University Federico II of Naples, Napoli, Italy
| | - Eugenio Stabile
- Hypertension Research Center, University Federico II of Naples, Napoli, Italy; Department of Advanced Biomedical Sciences, University Federico II of Naples, Napoli, Italy
| | - Nicola De Luca
- Hypertension Research Center, University Federico II of Naples, Napoli, Italy; Department of Advanced Biomedical Sciences, University Federico II of Naples, Napoli, Italy
| | - Giovanni de Simone
- Hypertension Research Center, University Federico II of Naples, Napoli, Italy; Department of Translational Medicine, University Federico II of Naples, Napoli, Italy.
| | - Bruno Trimarco
- Hypertension Research Center, University Federico II of Naples, Napoli, Italy; Department of Advanced Biomedical Sciences, University Federico II of Naples, Napoli, Italy
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Independent Echocardiographic Markers of Cardiovascular Involvement in Chronic Kidney Disease: The Value of Left Atrial Function and Volume. J Am Soc Echocardiogr 2016; 29:359-67. [DOI: 10.1016/j.echo.2015.11.019] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Indexed: 02/07/2023]
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Han JH, Han JS, Kim EJ, Doh FM, Koo HM, Kim CH, Lee MJ, Oh HJ, Park JT, Han SH, Ryu DR, Yoo TH, Kang SW. Diastolic dysfunction is an independent predictor of cardiovascular events in incident dialysis patients with preserved systolic function. PLoS One 2015; 10:e0118694. [PMID: 25739020 PMCID: PMC4349827 DOI: 10.1371/journal.pone.0118694] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 01/23/2015] [Indexed: 01/20/2023] Open
Abstract
Background Diastolic heart failure (HF), the prevalence of which is gradually increasing, is associated with cardiovascular (CV) morbidity and mortality in the general population and, more specifically, in patients with end-stage renal disease (ESRD). However, the impact of diastolic dysfunction on CV outcomes has not been studied in incident dialysis patients with preserved systolic function. Methods This prospective observational cohort study investigates the clinical consequence of diastolic dysfunction and the predictive power of diastolic echocardiographic parameters for CV events in 194 incident ESRD patients with normal or near normal systolic function, who started dialysis between July 2008 and August 2012. Results During a mean follow-up duration of 27.2 months, 57 patients (29.4%) experienced CV events. Compared to the CV event-free group, patients with CV events had a significantly higher left ventricular (LV) mass index, ratio of early mitral flow velocity (E) to early mitral annulus velocity (E’) (E/E’), LA volume index (LAVI), deceleration time, and right ventricular systolic pressure, and a significantly lower LV ejection fraction and E’. In multivariate Cox proportional hazard analysis, E/E’>15 and LAVI>32 mL/m2 significantly predicted CV events (E/E’>15: hazard ratio [HR] = 5.40, 95% confidence interval [CI] = 2.73–10.70, P< .001; LAVI>32 mL/m2: HR = 5.56, 95% CI = 2.28–13.59, P< .001]. Kaplan-Meier analysis revealed that patients with both E/E’>15 and LAVI>32mL/m2 had the worst CV outcomes. Conclusion An increase in E/E’ or LAVI is a significant risk factor for CV events in incident dialysis patients with preserved LV systolic function.
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Affiliation(s)
- Jae Hyun Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Suk Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Jin Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Fa Mee Doh
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hyang Mo Koo
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Chan Ho Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Mi Jung Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hyung Jung Oh
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Tak Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Hyeok Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Dong-Ryeol Ryu
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Tae-Hyun Yoo
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Shin-Wook Kang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Severance Biomedical Science Institute, Brain Korea 21 PLUS project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
- * E-mail:
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Abd ElHafeez S, Tripepi G, Stancanelli B, Dounousi E, Malatino L, Mallamaci F, Zoccali C. Norepinephrine, left ventricular disorders and volume excess in ESRD. J Nephrol 2015; 28:729-37. [DOI: 10.1007/s40620-015-0182-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 02/06/2015] [Indexed: 01/25/2023]
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Koo HM, Doh FM, Kim CH, Lee MJ, Kim EJ, Han JH, Han JS, Ryu DR, Oh HJ, Park JT, Han SH, Yoo TH, Kang SW. Changes in echocardiographic parameters according to the rate of residual renal function decline in incident peritoneal dialysis patients. Medicine (Baltimore) 2015; 94:e427. [PMID: 25700308 PMCID: PMC4554171 DOI: 10.1097/md.0000000000000427] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Residual renal function (RRF) is associated with left ventricular (LV) hypertrophy as well as all-cause and cardiovascular (CV) mortality in patients with end-stage renal disease. However, no studies have yet examined the serial changes in echocardiographic findings according to the rate of RRF decline in incident dialysis patients. A total of 81 patients who started peritoneal dialysis (PD) between 2005 and 2012 at Yonsei University Health System, Seoul, South Korea, and who underwent baseline and follow-up echocardiography within the first year of PD were recruited. Patients were dichotomized into "faster" and "slower" RRF decline groups according to the median values of RRF decline slope (-1.60 mL/min/y/1.73 m(2)). Baseline RRF and echocardiographic parameters were comparable between the 2 groups. During the first year of PD, there were no significant changes in LV end-diastolic volume index (LVEDVI), left atrial volume index (LAVI), or LV mass index (LVMI) in the "faster" RRT decline group, while these indices decreased in the "slower" RRT decline group. The rate of RRF decline was a significant determinant of 1-year changes in LVEDVI, LAVI, and LVMI. The linear mixed model further confirmed that there were significant differences in the changes in LVEDVI, LAVI, and LVMI between the 2 groups (P = 0.047, 0.048, and 0.001, respectively). During a mean follow-up duration of 31.9 months, 4 (4.9%) patients died. Compared with the "slower" RRF decline group, CV composite (20.29/100 vs 7.18/100 patient-years [PY], P = 0.098), technique failure (18.80/100 vs 4.19/100 PY, P = 0.006), and PD peritonitis (15.73/100 vs 4.95/100 PY, P = 0.064) developed more frequently in patients with "faster" RRF decline rate. On multivariate Cox regression analysis, patients with "faster" RRF decline rate showed 4.82-, 4.44-, and 7.37-fold higher risks, respectively, for each clinical outcome. Preservation of RRF is important for conserving cardiac performance, resulting in an improvement in clinical outcomes of incident PD patients.
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Affiliation(s)
- Hyang Mo Koo
- From the Department of Internal Medicine (HMK, FMD, CHK, MJL, EJK, JHH, JSH, HJO, JTP, SHH, T-HY, S-WK), College of Medicine, Yonsei University; Department of Internal Medicine (D-RR), School of Medicine, Ewha Womans University; and Severance Biomedical Science Institute (S-WK), Brain Korea 21 PLUS Project for Medical Science, Yonsei University, Seoul, South Korea
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Intradialytic hypotension and cardiac remodeling: a vicious cycle. BIOMED RESEARCH INTERNATIONAL 2015; 2015:724147. [PMID: 25654122 PMCID: PMC4310253 DOI: 10.1155/2015/724147] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 09/19/2014] [Indexed: 01/17/2023]
Abstract
Hemodynamic instability during hemodialysis is a common but often underestimated issue in the nephrologist practice. Intradialytic hypotension, namely, a decrease of systolic or mean blood pressure to a certain level, prohibits the safe and smooth achievement of ultrafiltration and solute removal goal in chronic dialysis patients. Studies have elucidated the potential mechanisms involved in the development of Intradialytic hypotension, including excessive ultrafiltration and loss of compensatory mechanisms for blood pressure maintenance. Cardiac remodeling could also be one important piece of the puzzle. In this review, we intend to discuss the role of cardiac remodeling, including left ventricular hypertrophy, in the development of Intradialytic hypotension. In addition, we will also provide evidence that a bidirectional relationship might exist between Intradialytic hypotension and left ventricular hypertrophy in chronic dialysis patients. A more complete understanding of the complex interactions in between could assist the readers in formulating potential solutions for the reduction of both phenomena.
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Abstract
Patients with chronic kidney disease (CKD) carry a high cardiovascular risk. In this patient group, cardiac structure and function are frequently abnormal and 74% of patients with CKD stage 5 have left ventricular hypertrophy (LVH) at the initiation of renal replacement therapy. Cardiac changes, such as LVH and impaired left ventricular systolic function, have been associated with an unfavourable prognosis. Despite the prevalence of underlying cardiac abnormalities, symptoms may not manifest in many patients. Fortunately, a range of available and emerging cardiac imaging tools may assist with diagnosing and stratifying the risk and severity of heart disease in patients with CKD. Moreover, many of these techniques provide a better understanding of the pathophysiology of cardiac abnormalities in patients with renal disease. Knowledge of the currently available cardiac imaging modalities might help nephrologists to choose the most appropriate investigative tool based on individual patient circumstances. This Review describes established and emerging cardiac imaging modalities in this context, and compares their use in CKD patients with their use in the general population.
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Han SS, Cho GY, Park YS, Baek SH, Ahn SY, Kim S, Chin HJ, Chae DW, Na KY. Predictive value of echocardiographic parameters for clinical events in patients starting hemodialysis. J Korean Med Sci 2015; 30:44-53. [PMID: 25552882 PMCID: PMC4278026 DOI: 10.3346/jkms.2015.30.1.44] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 09/04/2014] [Indexed: 12/18/2022] Open
Abstract
Echocardiographic parameters can predict cardiovascular events in several clinical settings. However, which echocardiographic parameter is most predictive of each cardiovascular or non-cardiovascular event in patients starting hemodialysis remains unresolved. Echocardiography was used in 189 patients at the time of starting hemodialysis. We established primary outcomes as follows: cardiovascular events (ischemic heart disease, cerebrovascular disease, peripheral artery disease, and acute heart failure), fatal non-cardiovascular events, all-cause mortality, and all combined events. The most predictable echocardiographic parameter was determined in the Cox hazard ratio model with a backward selection after the adjustment of multiple covariates. Among several echocardiographic parameters, the E/e' ratio and the left ventricular end-diastolic volume (LVEDV) were the strongest predictors of cardiovascular and non-cardiovascular events, respectively. After the adjustment of clinical and biochemical covariates, the predictability of E/e' remained consistent, but LVEDV did not. When clinical events were further analyzed, the significant echocardiographic parameters were as follows: s' for ischemic heart disease and peripheral artery disease, LVEDV and E/e' for acute heart failure, and E/e' for all-cause mortality and all combined events. However, no echocardiographic parameter independently predicted cerebrovascular disease or non-cardiovascular events. In conclusion, E/e', s', and LVEDV have independent predictive values for several cardiovascular and mortality events.
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Affiliation(s)
- Seung Seok Han
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Goo-Yeong Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Youn Su Park
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seon Ha Baek
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Shin Young Ahn
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sejoong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ho Jun Chin
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong-Wan Chae
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ki Young Na
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Reinecke H, Nabauer M, Gerth A, Limbourg T, Treszl A, Engelbertz C, Eckardt L, Kirchhof P, Wegscheider K, Ravens U, Meinertz T, Steinbeck G, Breithardt G. Morbidity and treatment in patients with atrial fibrillation and chronic kidney disease. Kidney Int 2015; 87:200-9. [DOI: 10.1038/ki.2014.195] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 03/28/2014] [Accepted: 04/03/2014] [Indexed: 11/09/2022]
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Patel RK, Pennington C, Stevens KK, Taylor A, Gillis K, Rutherford E, Johnston N, Jardine AG, Mark PB. Effect of left atrial and ventricular abnormalities on renal transplant recipient outcome-a single-center study. Transplant Res 2014; 3:20. [PMID: 25505546 PMCID: PMC4261520 DOI: 10.1186/s13737-014-0020-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 11/04/2014] [Indexed: 11/28/2022] Open
Abstract
Background Premature cardiovascular (CV) death is the commonest cause of death in renal transplant recipients. Abnormalities of left ventricular (LV) structure (collectively termed uremic cardiomyopathy) and left atrial (LA) dilation, a marker of fluid status and diastolic function, are risk factors for reduced survival in patients with end stage renal disease (ESRD). In the present analysis, we studied the impact of pre-transplant LA and LV abnormalities on survival after successful renal transplantation (RT). Methods One hundred nineteen renal transplant recipients (first transplant, deceased donors) underwent cardiovascular MRI (CMR) as part of CV screening prior to inclusion on the waiting list. Data regarding transplant function and patient survival after transplantation were collected. Results Median post-transplant follow-up was 4.3 years (interquartile range (IQR) 1.9, 6.2). During the post-transplant period, 13 patients returned to dialysis after graft failure and 23 patients died with a functioning graft. Survival analyses, censoring for patients returning to dialysis, showed that pre-transplant LV hypertrophy and elevated LA volume were significantly associated with reduced survival after transplantation. Multivariate Cox regression analyses demonstrated that longer waiting time, poorer transplant function, presence of LV hypertrophy and higher LA volume on screening CMR and female sex were independent predictors of death in patients with a functioning transplant. Conclusions Presence of LVH and higher LA volume are significant, independent predictors of death in patients who are wait-listed and proceed with renal transplantation.
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Affiliation(s)
- Rajan K Patel
- BHF Glasgow Cardiovascular Research, University of Glasgow, 126 University Place, Glasgow, G12 8TA UK ; Department of Renal Medicine, Western Infirmary, Dumbarton Road, Glasgow, G11 6NT UK
| | | | - Kathryn K Stevens
- BHF Glasgow Cardiovascular Research, University of Glasgow, 126 University Place, Glasgow, G12 8TA UK ; Department of Renal Medicine, Western Infirmary, Dumbarton Road, Glasgow, G11 6NT UK
| | - Alison Taylor
- BHF Glasgow Cardiovascular Research, University of Glasgow, 126 University Place, Glasgow, G12 8TA UK ; Department of Renal Medicine, Western Infirmary, Dumbarton Road, Glasgow, G11 6NT UK
| | - Keith Gillis
- BHF Glasgow Cardiovascular Research, University of Glasgow, 126 University Place, Glasgow, G12 8TA UK ; Department of Renal Medicine, Western Infirmary, Dumbarton Road, Glasgow, G11 6NT UK
| | - Elaine Rutherford
- BHF Glasgow Cardiovascular Research, University of Glasgow, 126 University Place, Glasgow, G12 8TA UK ; Department of Renal Medicine, Western Infirmary, Dumbarton Road, Glasgow, G11 6NT UK
| | - Nicola Johnston
- Department of Cardiology, Western Infirmary, Dumbarton Road, Glasgow, G11 6NT UK
| | - Alan G Jardine
- BHF Glasgow Cardiovascular Research, University of Glasgow, 126 University Place, Glasgow, G12 8TA UK ; Department of Renal Medicine, Western Infirmary, Dumbarton Road, Glasgow, G11 6NT UK
| | - Patrick B Mark
- BHF Glasgow Cardiovascular Research, University of Glasgow, 126 University Place, Glasgow, G12 8TA UK ; Department of Renal Medicine, Western Infirmary, Dumbarton Road, Glasgow, G11 6NT UK
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Relationship of left atrial size to obstructive sleep apnea severity in end-stage renal disease. Sleep Med 2014; 15:1314-8. [DOI: 10.1016/j.sleep.2014.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 06/24/2014] [Accepted: 07/03/2014] [Indexed: 11/24/2022]
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Rossi A, Gheorghiade M, Triposkiadis F, Solomon SD, Pieske B, Butler J. Left Atrium in Heart Failure With Preserved Ejection Fraction. Circ Heart Fail 2014; 7:1042-9. [DOI: 10.1161/circheartfailure.114.001276] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Andrea Rossi
- From the Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy (A.R.); Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); Department of Medicine, Cardiology Division, University of Larissa, Larissa, Greece (F.T.); Department of Medicine, Cardiology Division, Brigham and Womens Hospital, Harvard Medicine School, Boston, MA (S.D.S.); Department of Cardiology, Medical University Graz, Graz, Austria (B.P.); and Department of
| | - Mihai Gheorghiade
- From the Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy (A.R.); Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); Department of Medicine, Cardiology Division, University of Larissa, Larissa, Greece (F.T.); Department of Medicine, Cardiology Division, Brigham and Womens Hospital, Harvard Medicine School, Boston, MA (S.D.S.); Department of Cardiology, Medical University Graz, Graz, Austria (B.P.); and Department of
| | - Filippos Triposkiadis
- From the Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy (A.R.); Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); Department of Medicine, Cardiology Division, University of Larissa, Larissa, Greece (F.T.); Department of Medicine, Cardiology Division, Brigham and Womens Hospital, Harvard Medicine School, Boston, MA (S.D.S.); Department of Cardiology, Medical University Graz, Graz, Austria (B.P.); and Department of
| | - Scott D. Solomon
- From the Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy (A.R.); Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); Department of Medicine, Cardiology Division, University of Larissa, Larissa, Greece (F.T.); Department of Medicine, Cardiology Division, Brigham and Womens Hospital, Harvard Medicine School, Boston, MA (S.D.S.); Department of Cardiology, Medical University Graz, Graz, Austria (B.P.); and Department of
| | - Burkert Pieske
- From the Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy (A.R.); Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); Department of Medicine, Cardiology Division, University of Larissa, Larissa, Greece (F.T.); Department of Medicine, Cardiology Division, Brigham and Womens Hospital, Harvard Medicine School, Boston, MA (S.D.S.); Department of Cardiology, Medical University Graz, Graz, Austria (B.P.); and Department of
| | - Javed Butler
- From the Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy (A.R.); Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); Department of Medicine, Cardiology Division, University of Larissa, Larissa, Greece (F.T.); Department of Medicine, Cardiology Division, Brigham and Womens Hospital, Harvard Medicine School, Boston, MA (S.D.S.); Department of Cardiology, Medical University Graz, Graz, Austria (B.P.); and Department of
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Vincenti A, Passini E, Fabbrini P, Luise MC, Severi S, Genovesi S. Recurrent intradialytic paroxysmal atrial fibrillation: hypotheses on onset mechanisms based on clinical data and computational analysis. Europace 2014; 16:396-404. [PMID: 24569894 DOI: 10.1093/europace/eut346] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Atrial fibrillation (AF) incidence is high in end-stage renal disease (ESRD) patients, and haemodialysis (HD) session may induce paroxysmal AF episodes. Structural atrium remodelling is common in ESRD patients, moreover, HD session induces rapid plasma electrolytes and blood volume changes, possibly favouring arrhythmia onset. Therefore, HD session represents a unique model to study in vivo the mechanisms potentially inducing paroxysmal AF episodes. Here, we present the case report of a patient in which HD regularly induced paroxysmal AF. In four consecutive sessions, heart rate variability analysis showed a progressive reduction of low/high frequency ratio before the AF onset, suggesting a relative increase in vagal activity. Moreover, all AF episodes were preceded by a great increase of supraventricular ectopic beats. We applied computational modelling of cardiac cellular electrophysiology to these clinical findings, using plasma electrolyte concentrations and heart rate to simulate patient conditions at the beginning of HD session (pre-HD) and right before the AF onset (pre-AF), in a human atrial action potential model. Simulation results provided evidence of a slower depolarization and a shortened refractory period in pre-AF vs. pre-HD, and these effects were enhanced when adding acetylcholine effect. Paroxysmal AF episodes are induced by the presence of a trigger that acts upon a favourable substrate on the background of autonomic nervous system changes and in the described case report all these three elements were present. Starting from these findings, here we review the possible mechanisms leading to intradialytic AF onset.
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Affiliation(s)
- Antonio Vincenti
- Electrophysiology and Cardiac Pacing Unit, San Gerardo Hospital, 20900 Monza, Italy
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Friesen T, Jassal DS, Zhu M, Eng F, Rigatto C, Tangri N, Sood MM, Karlstedt E, Premecz S, Komenda P. Cardiovascular remodeling during long-term nocturnal home hemodialysis. Clin Exp Nephrol 2014; 19:514-20. [PMID: 24894700 PMCID: PMC4469297 DOI: 10.1007/s10157-014-0992-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 05/20/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cardiovascular disease is the leading cause of morbidity and mortality in patients with kidney failure. Nocturnal home hemodialysis (NHD) is a form of kidney replacement therapy whereby hemodialysis is performed for at least 6-h overnight, at least 4 days per week. Little is known about the effects of NHD on cardiovascular remodeling as assessed by transthoracic echocardiography (TTE) and cardiac magnetic resonance imaging (CMR). OBJECTIVES The primary objective of the study was to determine the long-term effects of NHD on cardiovascular remodeling using different imaging modalities over a one-year follow-up. METHODS AND RESULTS A total of 11 patients were included in the study (6 males, mean age 48 ± 16 years) between 2009 and 2011 inclusive at a single tertiary care center. All patients underwent TTE and CMR at baseline and after 1 year of NHD. Left ventricular mass index decreased significantly at 1 year by both TTE (152 ± 7-129 ± 8 g/m(2), p < 0.05) and CMR (162 ± 4-124 ± 4 g/m(2), p < 0.05). There was also a significant decrease in both left and right atrial volume as well as in right ventricular mass index over 1 year of follow-up. Diastolic dysfunction, graded from 0 to 4, improved from a baseline grade of 3.4 to 1.2 at 1-year follow-up. CONCLUSIONS Long-term nocturnal hemodialysis leads to favorable cardiovascular remodeling with a reduction in cavity dimensions, regression of left ventricular hypertrophy, and an improvement in diastolic function, as assessed by both TTE and CMR.
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Affiliation(s)
- Tyler Friesen
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Davinder S Jassal
- Institute of Cardiovascular Sciences, St. Boniface General Hospital, University of Manitoba, Winnipeg, MB, Canada
- Section of Cardiology, Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
- Department of Radiology, St. Boniface General Hospital, University of Manitoba, Winnipeg, MB, Canada
| | - Mike Zhu
- Section of Nephrology, Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Frederick Eng
- Section of Nephrology, Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Claudio Rigatto
- Section of Nephrology, Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
- Seven Oaks General Hospital Kidney Health Program, Winnipeg, MB, Canada
| | - Navdeep Tangri
- Section of Nephrology, Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
- Seven Oaks General Hospital Kidney Health Program, Winnipeg, MB, Canada
| | - Manish M Sood
- Section of Nephrology, Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Erin Karlstedt
- Institute of Cardiovascular Sciences, St. Boniface General Hospital, University of Manitoba, Winnipeg, MB, Canada
| | - Sheena Premecz
- Institute of Cardiovascular Sciences, St. Boniface General Hospital, University of Manitoba, Winnipeg, MB, Canada
| | - Paul Komenda
- Section of Nephrology, Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada.
- Seven Oaks General Hospital Kidney Health Program, Winnipeg, MB, Canada.
- University of Manitoba, Seven Oaks Hospital Renal Program, 2300 Mcphillips Street, 2PD12, Winnipeg, MB, R2V 3M3, Canada.
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Chiu DYY, Green D, Abidin N, Sinha S, Kalra PA. Echocardiography in hemodialysis patients: uses and challenges. Am J Kidney Dis 2014; 64:804-16. [PMID: 24751169 DOI: 10.1053/j.ajkd.2014.01.450] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 01/23/2014] [Indexed: 11/11/2022]
Abstract
Patients with end-stage renal disease undergoing hemodialysis have high rates of morbidity and mortality. Cardiovascular disease accounts for almost half of this mortality, with the single most common cause being sudden cardiac death. Early detection of abnormalities in cardiac structure and function may be important to allow timely and appropriate cardiac interventions. Echocardiography is noninvasive cardiac imaging that is widely available and provides invaluable information on cardiac morphology and function. However, it has limitations. Echocardiography is operator dependent, and image quality can vary depending on the operator's experience and the patient's acoustic window. Hemodialysis patients undergo regular hemodynamic changes that also may affect echocardiographic findings. An understanding of the prognostic significance and interpretation of echocardiographic results in this setting is important for patient care. There are some emerging techniques in echocardiographic imaging that can provide more detailed and accurate information compared with conventional 2-dimensional echocardiography. Use of these novel tools may further our understanding of the pathophysiology of cardiac disease in patients with end-stage renal disease undergoing hemodialysis.
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Affiliation(s)
- Diana Y Y Chiu
- Vascular Research Group, Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford; Institute of Population Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester
| | - Darren Green
- Vascular Research Group, Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford; Institute of Population Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester
| | - Nik Abidin
- Department of Cardiology, Salford Royal Hospital, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Smeeta Sinha
- Vascular Research Group, Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford; Institute of Population Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester
| | - Philip A Kalra
- Vascular Research Group, Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford; Institute of Population Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester.
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Kadappu KK, Kuncoro AS, Hee L, Aravindan A, Spicer ST, Suryanarayanan G, Xuan W, Boyd A, French JK, Thomas L. Chronic kidney disease is independently associated with alterations in left atrial function. Echocardiography 2014; 31:956-64. [PMID: 24447093 DOI: 10.1111/echo.12503] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is associated with increased cardiovascular morbidity and mortality; hence detection of early cardiovascular involvement in CKD is important to prevent future adverse cardiovascular events. Left atrial (LA) enlargement and dysfunction has been reported in end stage renal disease. However, there is a paucity of published data regarding the evaluation of LA function in CKD using noninvasive imaging parameters. In this study, we evaluated biplane LA volume as well as LA function (LA global systolic strain (GS) and strain rate [SR]) in stage 3 CKD patients (eGFR 30-59 mL/min per 1.73 m(2) ) to determine if LA function parameters are more significantly altered by the presence of CKD in addition to changes due to hypertension alone. METHODS Thirty-three CKD patients (eGFR 30-59 mL/min per 1.73 m(2) ) with hypertension were compared to 33 normal controls and 34 hypertensive (HT) subjects with normal renal function; all participants underwent a detailed transthoracic echocardiogram. Indexed biplane LA volume (LAVI), LA segmental function, and GS and SR (systolic, early, and late diastole) derived from tissue Doppler imaging (TDI) were measured. Univariate predictors of LA strain were determined. Multiple logistic regression analysis was used to examine the effect of patient group (i.e. CKD) on GS and SR as well as LAVI. RESULTS Left atrial volume indexed was significantly increased in both the HT and CKD with HT group compared to normal controls (28 ± 9 mL/m(2) vs. 28 ± 9 mL/m(2) vs. 23 ± 5 mL/m(2) , respectively, P = 0.02). However, LAVI was similar in the HT and CKD with HT group (28 ± 9 mL/m(2) vs. 28 ± 9 mL/m(2) ; P = NS). LA GS and SR were reduced in both the CKD with HT and HT group, compared to controls. However, a significantly lower LA GS was present in the CKD with HT group (Controls vs. HT vs. CKD with HT: 54.9 ± 14.5% vs. 34.5 ± 6.2% vs. 25.7 ± 9.3%, respectively; P = 0.001). To examine the effect of group, (i.e. presence of CKD) multiple logistic regression analysis was performed with univariate predictors including indexed left ventricular mass (LVMI), LV diastolic grade, LAVI, peak A-wave velocity, β-blocker therapy, GS and SR; this demonstrated that CKD had an independent effect on LA GS and SR (systolic, early, and late diastole). GS demonstrated moderate correlation with systolic blood pressure (r = -0.5, P = 0.01), diastolic grade (r = -0.5, P = 0.01), E' velocity (r = 0.6, P = 0.0001), peak A velocity (r = -0.5, P = 0.004), and LAVI (r = -0.6, P = 0.002). CONCLUSIONS Left atrial dysfunction is evident in stage 3 CKD with associated LA enlargement. This study demonstrates that LA GS and SR were reduced in the CKD group despite similar LAVI in the CKD with HT and HT group. Hence LA GS and SR may be a more sensitive noninvasive tool to detect cardiovascular involvement in CKD.
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Affiliation(s)
- Krishna K Kadappu
- South Western Sydney Clinical School, The University of New South Wales, Sydney, Australia; Cardiology Department, Liverpool Hospital, Liverpool, Australia; Cardiology Department, Campbelltown Hospital, University of West Sydney, Campbelltown, Australia
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Paoletti E, Zoccali C. A look at the upper heart chamber: the left atrium in chronic kidney disease. Nephrol Dial Transplant 2013; 29:1847-53. [PMID: 24286975 DOI: 10.1093/ndt/gft482] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Altered left ventricular (LV) mass and function are classical hallmarks of cardiomyopathy in chronic kidney disease (CKD). The left atrium (LA), a heart chamber exquisitely sensitive to volume overload and diastolic function, is an independent predictor of death and adverse cardiovascular (CV) events in high-risk patients such as those with hypertension and/or with heart failure. In this review we focus on the relationship of LA size with LV diastolic function, and the association between LA enlargement and CV and renal outcomes in patients with CKD, including patients with end-stage renal disease. Increased LA size emerges as a powerful predictor of mortality and major adverse CV events in both end-stage and early CKD, and some studies also show a close association between enlarged LA and renal disease progression. Secondary analyses of clinical trials suggest that the LA has the potential to be elected as a surrogate end point in CKD patients but the issue remains to be tested in specifically designed clinical studies.
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Affiliation(s)
- Ernesto Paoletti
- Nephrology, Dialysis, and Transplantation, University of Genoa, IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - Carmine Zoccali
- Renal and Transplantation Unit and CNR-IBIM, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Ospedali Riuniti, Reggio Calabria, Italy
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Takigawa M, Kuwahara T, Takahashi A, Kobori A, Takahashi Y, Okubo K, Watari Y, Sugiyama T, Kimura S, Takagi K, Hikita H, Hirao K, Isobe M. The impact of haemodialysis on the outcomes of catheter ablation in patients with paroxysmal atrial fibrillation. Europace 2013; 16:327-34. [PMID: 23918790 DOI: 10.1093/europace/eut230] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS The outcomes of catheter ablation (CA) in patients with paroxysmal atrial fibrillation (PAF) who are undergoing haemodialysis (HD) have not been fully elucidated. This study aimed to determine the impact of HD on CA outcome in these patients. METHODS AND RESULTS We examined 1364 consecutive PAF patients (mean age, 61 ± 10 years) who underwent CA, including 32 (2.3%) patients undergoing HD. The patients undergoing HD had a significantly lower body mass index (P < 0.0001), higher CHADS2 score (P = 0.006), and higher prevalence of structural heart disease (P < 0.0001), hypertension (P = 0.002), and congestive heart failure (P = 0.02). Echocardiography indicated a larger left atrial diameter (P < 0.0001) and left ventricular diameter (P = 0.0002) in the HD patients. Haemodialysis was a significant predictor of AF recurrence (hazard ratio 2.56; 95% confidence interval 1.56-4.03; P = 0.0004) in the overall population. Sinus rhythm maintenance rates in the HD patients at 1, 3, and 5 years were 42.3, 37.6, and 19.7%, respectively, after the first procedure, and 64.7, 54.9, and 47.1%, respectively, after the final procedure (median, 2; range, 1-2 procedures); these rates were significantly lower than those in the non-HD patients (P < 0.0001). The 5-year survival rate was 78.1% in the HD patients. CONCLUSION Haemodialysis was significantly associated with AF recurrence after CA for PAF. However, an ∼50% success rate for sinus rhythm maintenance without antiarrhythmic drug therapy in HD patients suggested that CA could be an option for the treatment of AF.
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Affiliation(s)
- Masateru Takigawa
- Cardiovascular Center, Yokosuka Kyosai Hospital, Yonegahama Street 1-16, Yokosuka, Kanagawa 238-8558, Japan
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Mallamaci F, Tripepi G. Salt and the heart in chronic kidney disease: an atrial connection. Nephrol Dial Transplant 2013; 28:2210-1. [DOI: 10.1093/ndt/gft195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Neumann CL, Wagner F, Menne J, Brockes C, Schmidt-Weitmann S, Rieken EM, Schettler V, Hagenah GC, Matzath S, Zimmerli L, Haller H, Schulz EG. Body weight telemetry is useful to reduce interdialytic weight gain in patients with end-stage renal failure on hemodialysis. Telemed J E Health 2013; 19:480-6. [PMID: 23614336 DOI: 10.1089/tmj.2012.0188] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Lacking compliance with liquid intake restrictions is one of the major problems in patients on hemodialysis and causes an increased mortality. In 120 patients on hemodialysis with an average interdialytic weight gain (IWG) exceeding 1.5 kg on at least 2 days during the 4 weeks preceding the intervention, the effect of telemetric body weight measurement (TBWM) on IWG, ultrafiltration rate, and blood pressure was evaluated over a period of 3 months. Patients of the telemetric group (TG) were supplied with automatic scales, which transferred the weight via telemetry on a daily basis. In the case of IWG of more than 0.75 kg/24 h, a telephonic contact was made as required, and in the case of an IWG of more than 1.5 kg, telephonic contacting was obligatory along with the advice of a liquid intake restriction to 0.5 L/day until the next dialysis. The patients of the control group (CG) received standard treatment without telemetric monitoring. We examined specific data of the second interdialytic interval (IDI2) and the average within 1 week. The average difference of IWG between TG and CG was not significant before the start of the study but 0.2 kg (p=0.027) (IDI2)/0.27kg (p=0.001) (WP) at the end of the study, respectively. The average difference in the ultrafiltration rate within 1 week was 19.0 mL/h (p=0.282) (IDI2)/8.2 mL/h (p=0.409) before the start of the study but 28.4 mL/h (p=0.122) (IDI2)/30.9 mL/h (p=0.004) at the end of the study, respectively. Thus, TBWM is a feasible method for optimizing the IWG and reducing the ultrafiltration rate.
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