Related Experiment Videos
Eccentric LVH healing after starting renal replacement therapy
Ugo Vertolli1, Mario Lupia, Agostino Naso
1Division of Nephrology, Hospital of Padova, Padua, Italy.
Insights
Standard hemodialysis effectively reversed severe left ventricular hypertrophy and mitral incompetence in a patient with chronic renal failure (CRF). This highlights the impact of managing uremic toxicity on cardiac function.
Area of Science:
- Nephrology
- Cardiology
- Internal Medicine
Background:
- Hypertension and left ventricular hypertrophy (LVH) are common in patients with chronic renal failure (CRF) undergoing regular dialysis therapy (RDT).
- Eccentric LVH with significant left ventricular dilatation and mitral regurgitation is a recognized complication.
Observation:
- A 62-year-old female patient starting hemodialysis (HD) presented with dyspnea and echocardiographic findings of dilated left atrium, moderately dilated left ventricle with normal systolic function, increased ventricular mass, and grade +3/4 mitral incompetence.
- After three months of standard RDT and a modest weight reduction, the patient became normotensive without medication.
Findings:
- Hemodynamic and echocardiographic studies revealed a normalized left ventricle with preserved systolic function and complete resolution of mitral regurgitation.
- Coronary angiography showed no critical stenosis, suggesting the cardiac changes were primarily related to hypertensive cardiomyopathy and uremic toxicity.
Implications:
- This case demonstrates that alleviating uremic toxicity through effective hemodialysis can significantly ameliorate cardiac performance, including reversing structural changes like LVH and functional issues like mitral incompetence.
- The findings suggest a potential for improving cardiovascular outcomes in CRF patients by optimizing dialysis therapy and managing associated toxicities.
Abstract:
Hypertension and left ventricular hypertrophy (LVH) are commonly associated in patients with CRF starting RDT. We report a case of eccentric LVH with marked dilatation and subsequent mitral incompetence of +3/4 that disappeared after three months of standard hemodialysis. Mrs SN, 62 years old, starting HD, had an echocardiography because of dyspnoea; the echo showed: dilated left atrium (78 ml/m2), moderately dilated left ventricle with normal systolic function (TDV 81 ml/m2, EF 66%), an increased ventricular mass (120 gr/m2) and a high grade mitral incompetence +3/4. After three months standard RDT and a dry weight only 2 kg less, the patients was normotensive without therapy, a cardiac angiogram with a hemodynamic study was performed as a pre-transplant workout: a normal left ventricle was found with normal systolic function (TDV 66, TSV 17, GS 49, EF 75%), and a perfectly competent mitral valve (reflux disappeared). The coronary angiography did not reveal critical stenosis. A new echocardiography confinned the data of the hemodynamic study: hypertensive cardiomiopathy with normal systolic function. After one year the patient has been transplanted, with a good renal function and the cardiac echo unchanged. Relieving uremic toxicity ameliorated the cardiac performance in this particular patient.