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Published on: May 31, 2016
Aortic stiffness and valvular calcifications in patients with end-stage renal disease
Tomasz Zapolski1, Andrzej Wysokiński, Lucyna Janicka
1Chair and Department of Cardiology, Medical University, Lublin, Poland. zapolia@wp.pl
Insights
Patients with end-stage renal disease (ESRD) exhibit increased aortic stiffness and more frequent cardiac calcifications. Aortic stiffness correlates with aortic valve damage and atherosclerotic plaques in ESRD patients.
Area of Science:
- Cardiology
- Nephrology
- Vascular Biology
Background:
- End-stage renal disease (ESRD) is associated with significant cardiovascular complications.
- Vascular calcification and arterial stiffness are common comorbidities in ESRD patients.
Purpose of the Study:
- To investigate the prevalence and extent of cardiac calcifications and aortic stiffness in patients with ESRD.
- To explore the relationship between aortic stiffness, calcifications, and cardiac function in ESRD.
Main Methods:
- Transthoracic echocardiography was performed on 60 ESRD patients undergoing peritoneal dialysis.
- Key echocardiographic parameters including left ventricular dimensions, contractility, and aortic/mitral valve areas were assessed.
- Aortic stiffness index (AS) was calculated, and aortic and mitral valve calcifications were evaluated.
Main Results:
- ESRD patients demonstrated enlarged left ventricles with thicker walls and reduced contractility (EF, FS).
- A higher incidence of atherosclerotic plaques, calcified plaques, and valvular calcifications was observed in ESRD patients.
- Significantly elevated aortic stiffness index (AS) values were found in ESRD patients compared to controls.
Conclusions:
- ESRD patients exhibit increased aortic stiffness and a higher burden of atherosclerotic and valvular calcifications.
- Aortic stiffness in ESRD correlates with aortic valve damage and aortic atherosclerotic plaque calcification.
- The pathogenesis of aortic calcification in ESRD may differ from calcifications in other locations.
Objectives:
To evaluate the presence and extent of cardiac calcifications and aortic stiffness in patients with end-stage renal disease (ESRD).
Patients And Methods:
The study group consisted of 60 patients with ESRD with a mean age of 51.7 years, treated with peritoneal dialysis. In all patients transthoracic echocardiogram was performed to assess the following parameters: left ventricular end-systolic diameter, left ventricular end-diastolic diameter (LVEDd), interventricular septum end-diastolic diameter (IVSDd), posterior wall end-diastolic diameter (PWDd), ejection fraction (EF), fractional shortening (FS), aortic maximal and minimal diameter, aortic valve area, mitral valve area (MVA), left ventricular ejection time (LVET), maximal aortic velocity. Aortic stiffness index (AS) was calculated. Aortic and mitral valve calcifications were assessed.
Results:
Patients with ESRD had a larger left ventricle (LVEDd 5.4 cm vs. 4.76 cm) and its wall was thicker (IVSDd 1.36 cm vs. 1.02 cm; PWDd 1.31 cm vs. 0.94 cm). Patients had poorer left ventricle contractility (EF 56.1 vs. 61.6%; FS 28.5 vs. 33.2%). Atherosclerotic plaques, calcified plaques and valvular calcifications were more frequently detected in patients with ESRD. Patients with ESRD had significantly higher values of the AS index: (5.34 vs. 3.24). Among ESRD subjects with the stiffer aorta, atherosclerotic plaques including calcificones and the aortic valve damage were more frequently detected.
Conclusions:
Patients with ESRD are characterized by increased aortic stiffness. Atherosclerotic plaques in the aorta as well as cardiac and large vessels calcifications are more common among patients with ESRD. In patients with ESRD there is a correlation between an increase in aortic stiffness and damage of aortic valvular leaflets as well as calcifications of atherosclerotic plaques in the aorta. The degree of aortic stiffness is not related to impairment of mitral valvular leaflets and extravalvular calcifications. A relationship between aortic stiffness and aortic or aortic valve calcifications suggest a different pathogenesis of aorta calcification as compared to that underlying calcifications of other localizations.
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