Myocardial changes in incident haemodialysis patients over 6-months: an observational cardiac magnetic resonance imaging study
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Published on: June 20, 2014
Elaine Rutherford1,2, Kenneth Mangion3, Christie McComb3
1Institute of Cardiovascular and Medical Sciences, University of Glasgow, BHF Building, 126 University Place, Glasgow, G12 8TA, UK. elaine.rutherford@glasgow.ac.uk.
Insights
Patients starting hemodialysis (HD) experience cardiac changes. Six months of HD improved left ventricular mass, myocardial strain, and reduced troponin levels, potentially lowering cardiovascular risk.
Area of Science:
- Cardiology
- Nephrology
- Medical Imaging
Background:
- Patients initiating hemodialysis (HD) face a higher risk of cardiovascular events within the first year.
- Left ventricular (LV) hypertrophy and impaired myocardial strain are known predictors of mortality in HD patients.
- Understanding myocardial changes in incident HD patients is crucial for assessing cardiovascular risk.
Purpose of the Study:
- To investigate the impact of six months of HD on cardiac structure and function in incident HD patients.
- To assess changes in left ventricular (LV) mass, myocardial strain, and T1 mapping using cardiac magnetic resonance (CMR).
- To evaluate alterations in pre-dialysis highly sensitive troponin T levels.
Main Methods:
- Cardiac magnetic resonance (CMR) imaging was performed at baseline and after six months.
- The study included 33 patients undergoing HD for less than 12 months.
- Measurements included LV mass index, LV global longitudinal strain, myocardial T1 time, and highly sensitive troponin T.
Main Results:
- Six months of HD led to a significant reduction in LV mass index (78.8 to 69.9 g/m²).
- LV global longitudinal strain showed significant improvement (from -17.9% to -21.6%).
- Highly sensitive troponin T levels decreased significantly (from 38.8 to 30.8 pg/L), while T1 mapping changes were not significant.
Conclusions:
- Six months of hemodialysis is associated with significant improvements in LV mass and myocardial strain in incident patients.
- These cardiac improvements may contribute to the reduced cardiovascular risk observed in patients established on long-term HD.
- The study highlights potential benefits of early HD on cardiac health, warranting further investigation.
Abstract:
Patients commencing on haemodialysis (HD) have an increased risk of cardiovascular events in the first year after starting HD compared to those patients established on HD longer. Left ventricular (LV) hypertrophy and abnormal myocardial strain predict mortality. There may be changes in the myocardium of incident HD patients over a 6-month period of HD which may explain changes in cardiovascular risk. We used CMR to consider changes in LV mass, myocardial strain and T1 mapping. We examined changes in pre-dialysis highly sensitive troponin T. 33 patients undergoing HD for <12 months were recruited. Participants underwent CMR at baseline and after 6-months of standard care. 6-months of HD was associated with reduction in LV mass index (Baseline: 78.8 g/m2 follow up: 69.9 g/m2, p = <0.001). LV global longitudinal strain also improved (Baseline: -17.9%, follow up: -21.6%, p = <0.001). Change in T1 time was not significant (Baseline septal T1 1277.4 ms, follow up 1271.5 p = 0.504). Highly sensitive troponin T was lower at follow up (Baseline 38.8 pg/L, follow up 30.8 pg/L p = 0.02). In incident HD patients, 6-months of HD was associated with improvements in LV mass, strain and troponin. These findings may reflect improvement in known cardiac tissue abnormalities found in patients over the first year of HD.
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