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[Cardiopathy in uremic dialyzed patients: transthoracic and transesophageal echocardiography]
F Robustelli della Cuna1, A Scarinci, M L Ghirimoldi
1Divisione del Cardiologia ed Unità Coronarica, Presidio Ospedaliero, Struttura di Sondrio.
Insights
Cardiovascular disease is common in chronic hemodialysis patients, with high rates of valvular disease, calcification, and left ventricular hypertrophy. Transesophageal echocardiography offers superior accuracy for detecting cardiac abnormalities compared to transthoracic echocardiography.
Area of Science:
- Cardiology
- Nephrology
- Medical Imaging
Background:
- Cardiovascular disease (CVD) is the primary cause of mortality in patients undergoing chronic hemodialysis.
- Despite advancements in dialysis, CVD remains a significant challenge in this population.
Purpose of the Study:
- To ascertain the prevalence of myocardial abnormalities in patients on chronic hemodialysis.
- To compare the diagnostic accuracy of transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) in this patient group.
Main Methods:
- Echocardiographic evaluation (TTE and TTE) was performed on 39 chronic hemodialysis patients.
- Assessment included left ventricular morphology and function, pericardial effusion, valvular disease, and calcification.
- Data from TTE and TEE were compared to determine diagnostic superiority.
Main Results:
- High prevalence of valvular disease (90%), calcifications (74%), and left ventricular hypertrophy (74%) were observed.
- Impaired diastolic (74%) and systolic (36%) cardiac function, along with left atrial enlargement (50%), were frequent.
- Pericardial effusion (7%), left atrial thrombi (7%), and coronary artery atherosclerotic plaques (10%) were less common.
Conclusions:
- TEE is more accurate than TTE for detecting cardiac calcification, valvular abnormalities, left atrial thrombi, and coronary artery disease.
- TEE provides a more comprehensive evaluation of cardiac structures and pathology in hemodialysis patients.
Background:
Despite progress and improvement in the dialysis modalities, cardiovascular disease remains the leading cause of death in patients receiving chronic hemodialysis therapy.
Methods:
To determine the prevalence of myocardial abnormalities among these patients, thirty-nine patients (22 males and 17 females, ranging in age from 20 to 87; mean age 61.38 +/- 15.04) underwent echocardiographic study. Twenty-seven were also examined by transesophageal echocardiogram. The morphology and function of the left ventricle as well as the presence of pericardial effusion, valvular disease and calcification were examined. The data obtained from transthoracic and transesophageal echocardiography were then compared.
Results:
The patients on chronic hemodialysis treatment showed a high prevalence of valvular disease (observed in 90% of the cases, but rarely hemodynamically relevant), calcifications (74%) and left ventricular hypertrophy (74%). Impaired cardiac function (diastolic dysfunction in 74% of the patients; systolic dysfunction in 36%) and left atrial enlargement (50%) were frequently observed. The incidence rates of pericardial effusion (7%) left atrial thrombi (7%) and atherosclerotic plaques of coronary arteries (10%) were uncommon.
Conclusions:
Transesophageal echocardiography is more accurate than transthoracic echocardiography in evaluating the presence of cardiac calcification (particularly of mitral apparatus), valvular leaflet mobility minor valvular regurgitation, left atrial and auricolar thrombi and spontaneous echocontrast, aortic and interatrial septum abnormalities and coronary artery atherosclerotic plaque.