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Heart function in patients with chronic glomerulonephritis and mildly to moderately impaired renal function. An
A P Schroeder1, B O Kristensen, C B Nielsen
1Department of Cardiology, Aarhus University Hospital, Skejby, Denmark.
Insights
Patients with chronic kidney disease show increased left ventricular mass and impaired systolic and diastolic function, independent of blood pressure or GFR. This suggests other factors contribute to early cardiac dysfunction in kidney disease.
Area of Science:
- Nephrology
- Cardiology
- Echocardiography
Background:
- Left ventricular hypertrophy and diastolic dysfunction are known complications in essential hypertension and chronic renal failure.
- However, the direct correlation with blood pressure levels is not consistently documented, suggesting other contributing factors.
- Chronic glomerulonephritis, even with mild to moderate renal impairment, may impact cardiac health.
Purpose of the Study:
- To investigate cardiac morphology and function in patients with chronic glomerulonephritis.
- To examine the relationship between echocardiographic findings and glomerular filtration rate (GFR), blood pressure (BP), and age.
- To identify early signs of cardiac dysfunction in chronic kidney disease.
Main Methods:
- Echocardiographic assessment (2D, M-mode, Doppler) in 20 patients with chronic glomerulonephritis and 14 healthy controls.
- Measurement of GFR using plasma clearance of Cr-EDTA.
- Analysis of left ventricular (LV) posterior wall thickness, LV mass index, systolic function (fractional shortening, ejection fraction), and diastolic function (mitral and tricuspid inflow velocities, E/A ratios).
Main Results:
- Patients exhibited significantly increased LV posterior wall thickness and LV mass index compared to controls.
- Systolic function, indicated by LV fractional shortening and ejection fraction, was significantly lower in patients.
- Diastolic dysfunction was evident in patients, characterized by reduced early peak flow velocity and E/A ratios in mitral inflow, with similar trends in tricuspid inflow.
- Age showed a significant negative correlation with mitral and tricuspid E/A ratios and VTI-E/A.
Conclusions:
- Patients with chronic glomerulonephritis and impaired renal function demonstrate increased LV mass and reduced systolic function.
- Diastolic dysfunction of the left ventricle is a significant finding in this patient group.
- Echocardiographic cardiac abnormalities were not correlated with blood pressure or GFR, indicating that factors beyond BP and renal function play a role in early cardiac dysfunction in chronic kidney disease.
Unlabelled:
Left ventricular hypertrophy and diastolic heart dysfunction have been reported in essential hypertension and in patients with chronic renal failure, treated with haemodialysis, but a close association with blood pressure (BP) level has not been uniformly documented. Thus, other factors could be involved in the pathogenesis of cardiac dysfunction. The aims of the present echocardiographic study were to investigate cardiac morphology and function in patients with chronic glomerulonephritis with mildly to moderately impaired renal function, and to study the relation between echocardiographic findings and glomerular filtration rate (GFR), BP and age. Twenty patients with chronic glomerulonephritis and 14 healthy controls, of the same age- and sex-distribution, were examined by 2D-, M-mode and pulsed-wave Doppler echocardiography. In patients, GFR was determined as plasma clearance of Cr-EDTA. The patients had significantly thicker left ventricular (LV) posterior walls in end diastole (8.7 vs 8.1 mm, p < 0.05), and a higher LV mass index (106.5 vs 93.8 g/m2, p < 0.05). Systolic functional indices, i.e. LV fractional shortening and LV ejection fraction, were statistically significantly lower in patients than in controls (p < 0.05). LV diastolic function in patients was characterized by a statistically significantly lower early peak flow velocity (E-Vmax) (0.66 compared with 0.8 m/s) and early to late peak flow velocity ratio (E/A ratio) (1.07 vs 1.41), as well as E/A ratio of time velocity indices (VTI-E/A) (1.45 vs 1.99) (p < 0.05). The right ventricular filling indices showed a tendency towards a lower E-Vmax in patients (0.55 compared with 0.62 m/s, p = 0.1). In patients, statistically significant negative correlations were found between age and mitral E/A ratio (r = -0.76, p < 0.0001), as well as LV VTI-E/A(r = -0.81, p < 0.0001). The same trend was seen for the tricuspid E/A ratio. No statistically significant correlations were found in patients between mitral or tricuspid E/A ratio and GFR, BP, LV mass or heart rate.
In Conclusion:
in a group of patients with chronic glomerulonephritis and mildly to moderately impaired renal function, it was found by means of echocardiography that there was a higher LV mass index and decreased systolic function, when compared with healthy controls. In addition, the patients had diastolic dysfunction of primarily the left ventricle. The echocardiographic findings were not correlated to BP level or renal function. This suggests that factors other than GFR or BP per se might be involved in the pathogenesis of cardiac dysfunction, at an early stage.