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Cardiac remodelling and functional alterations in mild-to-moderate renal dysfunction: comparison with healthy
Anna M Asp1, Carin Wallquist, Anette Rickenlund
1Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Insights
Chronic kidney disease (CKD) is linked to early cardiac abnormalities, including altered systolic and diastolic function and increased left ventricular hypertrophy (LVH). These changes suggest a precursor to premature cardiac morbidity in CKD patients.
Area of Science:
- Cardiology
- Nephrology
- Cardiorenal Medicine
Background:
- Left ventricular (LV) hypertrophy (LVH) and reduced LV function are associated with poor prognosis in chronic kidney disease (CKD).
- Investigating cardiac abnormalities in mild-to-moderate CKD is crucial for understanding disease progression.
Purpose of the Study:
- To determine if mild-to-moderate CKD is associated with cardiac abnormalities.
- To assess systolic and diastolic myocardial function in CKD patients.
Main Methods:
- Echocardiography with tissue Doppler imaging in 103 CKD patients (stages 2-5) and 53 controls.
- Measurement of systolic (s') and diastolic myocardial velocities (e'), and transmitral flow velocity (E).
- Calculation of the E/e' ratio to assess diastolic function.
Main Results:
- CKD patients exhibited significantly higher mean E/e' ratios compared to controls, indicating impaired diastolic function.
- Lower longitudinal systolic function (atrio-ventricular plane displacement and s') was observed in CKD groups.
- Increased prevalence of LVH was found in CKD patients (30-37%) versus controls (13%).
Conclusions:
- Mild-to-moderate CKD is associated with significant alterations in systolic and diastolic myocardial function.
- Cardiac involvement begins early in the course of CKD.
- These early cardiac changes may predispose CKD patients to premature cardiac morbidity.
Introduction:
Left ventricular (LV) hypertrophy (LVH) and reduced LV function correlate with poor prognosis in patients with chronic kidney disease (CKD). Our aim is to investigate whether mild-to-moderate CKD is associated with cardiac abnormalities.
Methods:
Echocardiography, including tissue Doppler imaging, was performed in 103 patients with CKD at stages 2-3 and 4-5, and in 53 healthy controls. The systolic (s') and diastolic myocardial velocity (e'), and the transmitral diastolic flow velocity (E) were measured, and E/e' was calculated.
Results:
Patients with chronic kidney disease had higher mean E/e' than controls (mean E/e': controls 5·00 ± 1·23 versus CKD 4-5 6·36 ± 1·71, P<0·001 and versus CKD 2-3 5·69 ± 1·47, P = 0·05), indicating altered diastolic function in the patients. The CKD groups showed lower longitudinal systolic function than controls, as assessed by atrio-ventricular plane displacement and s' (mean s': controls 11·5 ± 1·9 cm s(-1) versus CKD 4-5 10·4 ± 2·1 cm s(-1) , P = 0·03 and versus CKD 2-3 10·4 ± 2·1 cm s(-1) , P = 0·02). The prevalence of LVH was higher in patients with CKD than in controls (controls 13% versus CKD 4-5 37%, P = 0·006 and versus CKD 2-3 30%, P = 0·03).
Conclusion:
Alterations in systolic and diastolic myocardial function can be seen in mild-to-moderate CKD compared with controls, indicating that cardiac involvement starts early in CKD, which may be a precursor of premature cardiac morbidity.
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