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Structure and function of the left ventricle and carotid artery in hemodialysis patients
H Kawada1, T Sumimoto, H Okayama
1Department of Cardiology, Kitaishikai Hospital, Ehime, Japan. hkawada@shikoku.ne.jp
Insights
Hemodialysis patients experience accelerated atherosclerosis and arteriosclerosis in the carotid artery and increased left ventricular mass index (LVMi), indicating cardiac dysfunction. Hypertension further exacerbates these cardiovascular changes.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Medical Imaging
Background:
- Hypertension is common in hemodialysis patients, increasing cardiovascular complication risk.
- Understanding the impact of hypertension and hemodialysis on vascular and cardiac structures is crucial.
Purpose of the Study:
- To assess hypertension's effects on carotid artery structure/function and left ventricle (LV) in hemodialysis patients.
- To investigate the contributions of hemodialysis and other risk factors.
Main Methods:
- Compared carotid artery (intima-media thickness, plaque score, stiffness) and LV (mass index, fractional shortening) parameters in hemodialysis patients (with/without hypertension), hypertensive patients, and normotensive controls.
- Utilized ultrasonography and echocardiography.
- Performed multivariate regression analysis.
Main Results:
- Hemodialysis patients with hypertension showed increased carotid artery plaque and stiffness.
- Both hemodialysis and hypertension independently predicted increased LV mass index (LVMi).
- Hemodialysis alone worsened carotid artery atherosclerosis/arteriosclerosis and caused cardiac dysfunction (reduced midwall fractional shortening).
Conclusions:
- Hemodialysis itself promotes carotid artery atherosclerosis and arteriosclerosis, increases LVMi, and impairs cardiac function.
- Associated hypertension accelerates these vascular and cardiac changes in hemodialysis patients.
Abstract:
Hemodialysis patients frequently show associated hypertension, which can lead to a number of cardiovascular complications. The aim of this study was to assess the effects of hypertension on the structure and function of the carotid artery and left ventricle (LV) in hemodialysis patients. In addition, we investigated the contribution of hemodialysis and other risk factors. Fifty-two hemodialysis patients, 71 hypertensive patients (HT group) and 30 normotensive subjects (NT group) were included in this study. Hemodialysis patients were divided into two groups: 35 patients with hypertension (HDHT group), and 17 patients without hypertension (HDNT group). We measured intima-media thickness (IMT), plaque score, end-diastolic diameter, and stiffness index beta of the carotid artery by ultrasonography, and LV mass index (LVMi), endocardial fractional shortening (FS), and midwall FS (MWS) by echocardiography. A multiple stepwise regression analysis including hemodialysis, hypertension, diabetes mellitus, and other risk factors was also performed. IMT was significantly higher in the HT and HDHT groups than in the NT group. Plaque score and diameter of the carotid artery were higher in the HDHT group than in the other three groups. The stiffness index beta was higher in the HDHT group than in the non-hemodialysis groups. In multivariate analysis, IMT was independently correlated with age and hypertension. Plaque score and stiffness index beta were independently associated with age, hypertension, and hemodialysis. LVMi was higher in HT and hemodialysis-patients groups than in the NT group. Hypertension and hemodialysis were strong and independent predictors of LVMi. FS showed no significant differences among the four groups, but MWS was significantly lower among the hemodialysis patients than in the NT group. MWS was independently correlated with hemodialysis and diabetes. In conclusion, hemodialysis per se advanced both atherosclerosis and arteriosclerosis of the carotid artery. Moreover, it increased LVMi and caused cardiac dysfunction. Associated hypertension might thus accelerate the progression of atherosclerosis and arteriosclerosis of the carotid artery and the increase of LVMi.