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Published on: June 23, 2015
Cardiac involvement in autosomal-dominant polycystic kidney disease: a hypertensive heart disease
A Bardají1, A Martinez-Vea, A Valero
1Department of Medicine and Surgery, Hospital Universitari de Tarragona, Joan XXIII, University Rovira i Virgili, Spain. abardaji@galenics.com
Insights
Cardiovascular abnormalities progress with autosomal-dominant polycystic kidney disease (ADPKD), showing increased left ventricular mass and hypertrophy, especially in later stages. Blood pressure significantly influences these cardiac changes in ADPKD patients.
Area of Science:
- Nephrology
- Cardiology
- Genetics
Background:
- Limited data exists on cardiovascular abnormalities in autosomal-dominant polycystic kidney disease (ADPKD).
- This study investigated the prevalence and characteristics of cardiac involvement in ADPKD patients.
Purpose of the Study:
- To determine the profile and prevalence of cardiac abnormalities in ADPKD patients.
- To assess the progression of cardiovascular changes across different stages of ADPKD.
Main Methods:
- A cross-sectional study involving 130 ADPKD patients.
- Patients were categorized into normotensive, hypertensive, and hemodialysis groups.
- Doppler color echocardiography was utilized to evaluate cardiac parameters.
Main Results:
- A significant, progressive increase in left ventricular mass (LVM) index and left ventricular hypertrophy (LVH) was observed across the groups (p < 0.0001).
- Diastolic dysfunction, indicated by E/A ratio < 1, was more prevalent in hypertensive and hemodialysis groups (46% and 62%, respectively).
- Valvular abnormalities, including calcification, were more common in dialysis patients, with blood pressure, age, and creatinine identified as key predictors of LVM index.
Conclusions:
- Cardiac involvement in ADPKD is a progressive process, worsening with disease advancement.
- The study highlights increasing LVM, LVH, and diastolic dysfunction as key features.
- Blood pressure is a major determinant of cardiovascular abnormalities in ADPKD.
Background:
There is little information regarding the occurrence and distribution of cardiovascular abnormalities during the course of autosomal-dominant polycystic kidney disease (ADPKD). We conducted a cross-sectional study in three different groups of ADPKD patients to determine the profile and prevalence of cardiac involvement in this population.
Methods:
Doppler color echocardiography was performed in 130 ADPKD patients. Patients were divided into normotensive (Group I, n=60), hypertensive (Group II, n=32) and those undergoing hemodialysis (Group III, n=38).
Results:
There was a progressive increase in left ventricular mass (LVM) index (88.6+/-19.7, 127.6+/-40.4 and 150.5+/-56.5 g/m2, p < 0.0001) and in the prevalence of left ventricular hypertrophy (LVH) (3%, 43%, 62%, p < 0.0001) in Groups I, II and III, respectively. E/A ratio < 1 was found in 2% of normotensives, 46% of hypertensives and 62% of hemodialysis patients (p < 0.0001). Prevalence ofmitral valve prolapse and aortic and/or mitral regurgitation was 4.3% and 8.6%, respectively, in non-dialysis patients. The majority of valvular abnormalities occurred in dialysis patients, and were generally related to annular mitral calcification (28%) or aortic valve calcification (38%). Age, sex, systolic blood pressure (BP) and hemoglobin were independent predictors of LVM index in the entire population, systolic BP and creatinine in non-dialysis patients and systolic BP in dialysis patients. Age, heart rate and diastolic BP in the entire group, and age, heart rate and LVM index in non-dialysis patients remained as independent predictors of abnormal diastolic function.
Conclusions:
Cardiac involvement in ADPKD patients is a continuous process that evolves during the course of this disease. It is characterized by a low prevalence of specific valvular abnormalities, a progressive increase in LVM, LVH, and diastolic dysfunction, which are greatest in the latter stages of the disease. This study confirms the major influence of BP on cardiovascular abnormalities of ADPKD patients.
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