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Sági B, Késői I, Vas T, Csiky B, Nagy J, Kovács T. Renal and cardiovascular prognostic significance of echocardiographic early diastolic mitral annular velocity in IgA nephropathy. Int J Cardiovasc Imaging 2024; 40:307-319. [PMID: 37935940 PMCID: PMC10884064 DOI: 10.1007/s10554-023-02988-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 10/14/2023] [Indexed: 11/09/2023]
Abstract
In chronic kidney disease (CKD), as in IgA nephropathy (IgAN), cardiovascular (CV) mortality and morbidity are many times higher than in the general population, and diastolic dysfunction (LVDD) has prognostic significance as well. Tissue Doppler Echocardiography (TDI) is another method for measuring myocardial contractility and determining diastolic dysfunction. 79 IgAN patients (age 46 ± 11 years) with CKD stages 1-3 were investigated and followed for 70 ± 28.7 months. Doppler echocardiography was used to measure the E (early) and A (late) waves, as well as the E wave deceleration time (EDT) during mitral inflow. TDI was used to measure early (Ea) and late (Aa) diastolic velocities (lateral and septal basal wall fragment average). From these, we calculated the E/Ea and Ea/Aa ratios. The primary combined endpoints were total mortality, major CV events, and end-stage renal disease, and the secondary endpoints were cardiovascular or renal (eGFR decreased below 15 ml/min/1.73 m2 or renal replacement therapy was started). Patients with decreased Ea (< 13 cm/s) had significantly more endpoints (20/42 vs. 3/37; p = 0.001) than patients with higher Ea (≥ 13 cm/s). The secondary renal endpoints were also significantly higher (p = 0.004). In a multivariate model, the eGFR showed independent correlation with the E/A ratio (r = 0.466; p < 0.01), EDT (r = - 0.270; p < 0.01), Ea/Aa ratio (r = 0.455; p < 0.01), and decreased Ea (r = 0.544; p < 0.01). Independent factors influencing Ea were only EDT by uni- and multivariate regression but age and albuminuria by logistic regression. Decreased Ea measured by TDI seems to be an eligible factor to predict the prognosis of IgA nephropathy. The decreased Ea may be a helpful parameter to identify high-risk CKD patients.
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Affiliation(s)
- Balázs Sági
- 2nd Department of Internal Medicine and Nephrology, Diabetes Center, Medical School, Clinical Center, University of Pécs, Pacsirta Street 1., Pécs, 7624, Hungary
- Fresenius Medical Care Dialysis Center Pécs, Pécs, Hungary
| | - István Késői
- Department of Internal Medicine and Cardiology, Hospital of Mohács, Mohacs, Hungary
| | - Tibor Vas
- 2nd Department of Internal Medicine and Nephrology, Diabetes Center, Medical School, Clinical Center, University of Pécs, Pacsirta Street 1., Pécs, 7624, Hungary
| | - Botond Csiky
- 2nd Department of Internal Medicine and Nephrology, Diabetes Center, Medical School, Clinical Center, University of Pécs, Pacsirta Street 1., Pécs, 7624, Hungary
- Fresenius Medical Care Dialysis Center Pécs, Pécs, Hungary
| | - Judit Nagy
- 2nd Department of Internal Medicine and Nephrology, Diabetes Center, Medical School, Clinical Center, University of Pécs, Pacsirta Street 1., Pécs, 7624, Hungary
| | - Tibor Kovács
- 2nd Department of Internal Medicine and Nephrology, Diabetes Center, Medical School, Clinical Center, University of Pécs, Pacsirta Street 1., Pécs, 7624, Hungary.
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Sági B, Késői I, Vas T, Csiky B, Nagy J, Kovács TJ. Relationship between arterial stiffness, left ventricular diastolic function, and renal function in chronic kidney disease. BMC Nephrol 2023; 24:261. [PMID: 37661275 PMCID: PMC10476356 DOI: 10.1186/s12882-023-03308-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/24/2023] [Indexed: 09/05/2023] Open
Abstract
AIM In chronic kidney disease, IgA nephropathy, and left ventricular diastolic dysfunction have prognostic significance as well. However, the relationship between diastolic dysfunction, arterial stiffness, and renal function has not been fully elucidated. METHODS 79 IgA nephropathy patients (aged 46 ± 11 years) and 50 controls were investigated. Tissue Doppler imaging was used to measure early (Ea) and late (Aa) diastolic velocities. Arterial stiffness was measured by a photoplethysmographic (stiffness index (SI)) and an oscillometric method (aortic pulse wave velocity (PWVao)). RESULTS We compared the IgAN patients to a similar cardiovascular risk group with a preserved eGFR. A strong correlation was found between Ea/Aa and SI (p < 0.001), also with PWVao (p < 0.001), just in IgAN, and with eGFR (p < 0.001) in both groups. IgAN patients were divided into groups CKD1-2 vs. CKD3-5. In the CKD 3-5 group, the incidence of diastolic dysfunction increased significantly: 39% vs. 72% (p = 0.003). Left ventricle rigidity (LVR) was calculated, which showed a close correlation with SI (p = 0.009) and eGFR (p = 0.038). By linear regression analysis, the independent predictors of SI were age, E/A, and E/Ea; SI was the predictor of LVR; and E/A and hypertension were the predictors of eGFR. CONCLUSION In chronic kidney disease, increased cardiac rigidity and vascular stiffness coexist with decreased renal function, which is directly connected to diastolic dysfunction and vascular stiffness. On the basis of comparing the CKD group to the control group, vascular alterations in very early CKD can be identified.
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Affiliation(s)
- Balázs Sági
- 2nd Dept. of Internal Medicine and Nephrology, Diabetes Centre, Medical School, Clinical Center, University of Pécs, Pacsirta Street 1, Pécs, 7624, Hungary
| | - István Késői
- Mohács Hospital, Department of Internal Medicine Cardiology, Szepessy square 7, Mohács, 7700, Hungary
| | - Tibor Vas
- 2nd Dept. of Internal Medicine and Nephrology, Diabetes Centre, Medical School, Clinical Center, University of Pécs, Pacsirta Street 1, Pécs, 7624, Hungary
| | - Botond Csiky
- 2nd Dept. of Internal Medicine and Nephrology, Diabetes Centre, Medical School, Clinical Center, University of Pécs, Pacsirta Street 1, Pécs, 7624, Hungary
| | - Judit Nagy
- 2nd Dept. of Internal Medicine and Nephrology, Diabetes Centre, Medical School, Clinical Center, University of Pécs, Pacsirta Street 1, Pécs, 7624, Hungary
| | - Tibor József Kovács
- 2nd Dept. of Internal Medicine and Nephrology, Diabetes Centre, Medical School, Clinical Center, University of Pécs, Pacsirta Street 1, Pécs, 7624, Hungary.
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Sági B, Késői I, Vas T, Csiky B, Nagy J, Kovács TJ. Left ventricular myocardial mass index associated with cardiovascular and renal prognosis in IgA nephropathy. BMC Nephrol 2022; 23:285. [PMID: 35974314 PMCID: PMC9382800 DOI: 10.1186/s12882-022-02909-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/08/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction In chronic kidney disease (CKD), like in IgA nephropathy (IgAN), cardiovascular (CV) mortality and morbidity are many times higher than in the general population, and left ventricular hypertrophy (LVH) is an independent risk factor for CV disease. This follow-up study investigated the association between left ventricular mass index (LVMI) and renal or cardiovascular outcomes. Methods We examined 118 IgAN patients prospectively. LVMI and LV geometry was investigated using echocardiography. The primary combined endpoints were total mortality, major CV events, and end-stage renal disease. Secondary endpoints, i.e.—cardiovascular or renal endpoints,—were also examined separately. Results Sixty seven percent were males, mean age 53.5 ± 13.5. Mean follow-up time: 184 months. LVMI inversely correlated with eGFR (corr. coefficient: -0.365; p < 0.01). We divided the patients into two groups based on the LVMI cut-off suggested by the literature. The presence of LVH caused a worse prognosis in primary (p < 0.001), renal endpoints (p = 0.01), and also in CV endpoints (p = 0.001). The higher LVMI in men significantly worsened the prognosis in all endpoints. Concentric hypertrophy meant a worse prognosis. Independent predictors of LVMI were gender and eGFR in uni- and multivariate regression and hemoglobin levels only in logistic regression. Independent predictors of the primary endpoint were LVMI, eGFR, gender, obesity, HT, DM, and metabolic syndrome in Cox regression analysis. Conclusion Increased LVMI may predict the progression to end-stage renal disease and CV events in IgAN. Determining LVMI may be a useful parameter not only in CV risk but also in the stratification of renal risk in CKD.
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Affiliation(s)
- Balázs Sági
- Medical School, Clinical Center, 2Nd. Dep. of Internal Medicine and Nephrology, Diabetes Center, University of Pécs, 1 Pacsirta street, 7624, Pécs, Hungary.,Fresenius Medical Care Dialysis Center Pécs, Pecs, Hungary
| | - István Késői
- Department of Internal Medicine Cardiology, Mohács Hospital, Mohács, Hungary
| | - Tibor Vas
- Medical School, Clinical Center, 2Nd. Dep. of Internal Medicine and Nephrology, Diabetes Center, University of Pécs, 1 Pacsirta street, 7624, Pécs, Hungary
| | - Botond Csiky
- Medical School, Clinical Center, 2Nd. Dep. of Internal Medicine and Nephrology, Diabetes Center, University of Pécs, 1 Pacsirta street, 7624, Pécs, Hungary.,Fresenius Medical Care Dialysis Center Pécs, Pecs, Hungary
| | - Judit Nagy
- Medical School, Clinical Center, 2Nd. Dep. of Internal Medicine and Nephrology, Diabetes Center, University of Pécs, 1 Pacsirta street, 7624, Pécs, Hungary
| | - Tibor József Kovács
- Medical School, Clinical Center, 2Nd. Dep. of Internal Medicine and Nephrology, Diabetes Center, University of Pécs, 1 Pacsirta street, 7624, Pécs, Hungary.
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Sági B, Késői I, Vas T, Csiky B, Nagy J, Kovács T. The prognostic role of heart rate recovery after exercise and metabolic syndrome in IgA nephropathy. BMC Nephrol 2021; 22:390. [PMID: 34809611 PMCID: PMC8609750 DOI: 10.1186/s12882-021-02596-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 10/26/2021] [Indexed: 11/12/2022] Open
Abstract
Background Cardiovascular (CV) morbidity and mortality are higher in chronic kidney disease (CKD) than in the general population. Reduced heart rate recovery (HRR) is an independent risk factor for CV disease. The aim of the study was to determine the prognostic role of HRR in a homogenous group of CKD patients. Methods One hundred and twenty-five IgA nephropathy patients (82 male, 43 female, age 54.7 ± 13 years) with CKD stage 1–4 were investigated and followed for average 70 months. We performed a graded exercise treadmill stress test. HRR was derived from the difference of the peak heart rate and the heart rate at 1 min after exercise. Patients were divided into two groups by the mean HRR value (22.9 beats/min). The composite (CV and renal) endpoints included all-cause mortality and any CV event such as stroke, myocardial infarction, revascularisation (CV) and end-stage renal disease, renal replacement therapy (renal). Results Patients with reduced HRR (< 23 bpm) had significantly more end point events (22/62 patients vs. 9/53 patients, p = 0.013) compared to the higher HRR (≥23 bpm). Of the secondary the endpoints (CV or renal separately) rate of the renal endpoint was significantly higher in the lower HRR group (p = 0.029), while there was no significant difference in the CV endpoint between the two HRR groups (p = 0.285). Independent predictors of survival were eGFR and diabetes mellitus by using Cox regression analysis. Kaplan-Meier curves showed significant differences in metabolic syndrome and non-metabolic syndrome when examined at the combined endpoints (cardiovascular and renal) or at each endpoint separately. The primary endpoint rate was increased significantly with the increased number of metabolic syndrome component (Met.sy. comp. 0 vs. Met. sy. comp. 2+, primary endpoints, p = 0.012). Conclusion Our results showed that reduced HRR measured by treadmill exercise test has a predictive value for the prognosis of IgA nephropathy. The presence of metabolic syndrome may worsen the prognosis of IgA nephropathy.
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Affiliation(s)
- Balázs Sági
- 2nd Department of Internal Medicine and Nephrology, Diabetology Center, University of Pécs, Clinical Center Medical School, Pacsirta street 1, Pécs, 7624, Hungary.,Fresenius Medical Care Dialysis Center Pécs, Pécs, Hungary
| | - István Késői
- Internal Medicine Department, Health Center of Komló, Mining rehabilitation and Nighttime Sanatorium, Komló, Hungary
| | - Tibor Vas
- 2nd Department of Internal Medicine and Nephrology, Diabetology Center, University of Pécs, Clinical Center Medical School, Pacsirta street 1, Pécs, 7624, Hungary
| | - Botond Csiky
- 2nd Department of Internal Medicine and Nephrology, Diabetology Center, University of Pécs, Clinical Center Medical School, Pacsirta street 1, Pécs, 7624, Hungary.,Fresenius Medical Care Dialysis Center Pécs, Pécs, Hungary
| | - Judit Nagy
- 2nd Department of Internal Medicine and Nephrology, Diabetology Center, University of Pécs, Clinical Center Medical School, Pacsirta street 1, Pécs, 7624, Hungary.
| | - Tibor Kovács
- 2nd Department of Internal Medicine and Nephrology, Diabetology Center, University of Pécs, Clinical Center Medical School, Pacsirta street 1, Pécs, 7624, Hungary
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Sági B, Késői I, Késői B, Vas T, Csiky B, Kovács T, Nagy J. Arterial stiffness may predict renal and cardiovascular prognosis in autosomal-dominant polycystic kidney disease. Physiol Int 2018; 105:145-156. [DOI: 10.1556/2060.105.2018.2.17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background and aims
Autosomal-dominant polycystic kidney disease (ADPKD) is one of the most common causes of end-stage renal disease (ESRD). The most important cause of death among ADPKD patients is cardiovascular (CV). The aim of this study was to examine the prognostic significance of arterial stiffness on CV and renal outcomes in ADPKD.
Methods
A total of 55 patients with ADPKD were examined. Pulse wave velocity was determined and stiffness index (SIDVP) was calculated. Combined primary endpoints (CV and renal) were major CV events (myocardial infarction, stroke, and CV intervention) as CV endpoints, and attaining of ESRD or start of renal replacement therapy as renal endpoints. Secondary endpoints were CV or renal endpoints separately.
Results
The mean age of those 55 ADPKD patients was 45 ± 12 years, 21 patients were male. The average value of the SIDVP was 11.11 ± 2.22 m/s. The patients were divided into two groups by the cutoff value of 11 m/s of SIDVP and then outcomes were analyzed. In the higher arterial stiffness group (SIDVP > 11 m/s), occurrence of combined primary endpoint (CV and renal) was significantly higher than in the group with more elastic arteries (p = 0.033). A statistically significant difference was found in the renal endpoints (p = 0.018), but not in the CV endpoints (p = 0.952) between the two groups.
Conclusions
Increased arterial stiffness predicts the onset of ESRD in ADPDK. Assessment of SIDVP appears to be a useful method for estimating the renal and CV prognosis in ADPKD.
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Affiliation(s)
- B Sági
- 1 2nd Department of Internal Medicine and Nephrological Centre, Clinical Centre, Medical School, University of Pécs, Pécs, Hungary
| | - I Késői
- 2 Internal Medicine Department, Mining Rehabilitation and Night Time Sanatorium, Health Centre of Komló, Komló, Hungary
| | - B Késői
- 3 Department of Adult Cardiology, György Gottsegen National Institute of Cardiology, Budapest, Hungary
| | - T Vas
- 1 2nd Department of Internal Medicine and Nephrological Centre, Clinical Centre, Medical School, University of Pécs, Pécs, Hungary
| | - B Csiky
- 1 2nd Department of Internal Medicine and Nephrological Centre, Clinical Centre, Medical School, University of Pécs, Pécs, Hungary
| | - T Kovács
- 1 2nd Department of Internal Medicine and Nephrological Centre, Clinical Centre, Medical School, University of Pécs, Pécs, Hungary
| | - J Nagy
- 1 2nd Department of Internal Medicine and Nephrological Centre, Clinical Centre, Medical School, University of Pécs, Pécs, Hungary
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Késői I, Sági B, Vas T, Pintér T, Kovács T, Wittmann I, Nagy J. Cardiorenal syndromes. Orv Hetil 2011; 152:1520-7. [DOI: 10.1556/oh.2011.29212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Cardiac and kidney diseases are very common, and increasingly coexist. Classification for cardiorenal syndrome and for its specific subtypes has been developed and published recently by a consensus group of the Acute Dialysis Quality Initiative. Cardiorenal syndromes have been classified according to whether the impairment of each organ is primary, secondary or whether heart and kidney dysfunction occurs simultaneously as a systemic disease. The different syndromes were classified into five subtypes. Type-1: acute cardiorenal syndrome: an abrupt worsening of cardiac function leading to acute kidney injury and/or dysfunction. Type-2: chronic cardiorenal syndrome: chronic abnormalities in cardiac function causing kidney injury and/or dysfunction. Type-3: acute renocardiac syndrome: abrupt worsening of kidney function leading to heart injury and/or dysfunction. Type-4: chronic renocardiac syndrome: chronic kidney diseases leading to heart injury, disease and/or dysfunction. Type-5: secondary cardiorenal syndrome: acute or chronic systemic diseases leading to simultaneous injury and/or dysfunction of heart and kidney. The identification of patients and the pathophysiological mechanisms underlying each syndrome subtype will help cardiologists, nephrologists and physicians working on intensive care units to characterize groups of their patients with cardiac and renal impairment and to provide a more accurate treatment for them. Orv. Hetil., 2011, 152, 1520–1527.
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Affiliation(s)
- István Késői
- Pécsi Tudományegyetem, Általános Orvostudományi Kar, Klinikai Központ II. Belgyógyászati Klinika és Nefrológiai Centrum Pécs Pacsirta u. 1. 7624
- Komlói Egészségcentrum Nonprofit Kft. Általános Belgyógyászati Osztály Komló
| | - Balázs Sági
- Pécsi Tudományegyetem, Általános Orvostudományi Kar, Klinikai Központ II. Belgyógyászati Klinika és Nefrológiai Centrum Pécs Pacsirta u. 1. 7624
| | - Tibor Vas
- Pécsi Tudományegyetem, Általános Orvostudományi Kar, Klinikai Központ II. Belgyógyászati Klinika és Nefrológiai Centrum Pécs Pacsirta u. 1. 7624
| | - Tünde Pintér
- Pécsi Tudományegyetem, Általános Orvostudományi Kar, Klinikai Központ Szívgyógyászati Klinika Pécs
| | - Tibor Kovács
- Pécsi Tudományegyetem, Általános Orvostudományi Kar, Klinikai Központ II. Belgyógyászati Klinika és Nefrológiai Centrum Pécs Pacsirta u. 1. 7624
| | - István Wittmann
- Pécsi Tudományegyetem, Általános Orvostudományi Kar, Klinikai Központ II. Belgyógyászati Klinika és Nefrológiai Centrum Pécs Pacsirta u. 1. 7624
| | - Judit Nagy
- Pécsi Tudományegyetem, Általános Orvostudományi Kar, Klinikai Központ II. Belgyógyászati Klinika és Nefrológiai Centrum Pécs Pacsirta u. 1. 7624
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