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Coronary artery diameter and left ventricular function in patients on maintenance hemodialysis treatment: comparison
K Hatada1, T Sugiura, S Nakamura
1Second Department of Internal Medicine, Kansai Medical University, Osaka, Japan. hatada@takii.kmu.ac.jp
Insights
Diabetes mellitus in patients undergoing hemodialysis is linked to narrower coronary arteries and increased left ventricular end-diastolic pressure, despite no significant blockages. This impacts cardiac function in end-stage renal disease patients.
Area of Science:
- Cardiology
- Nephrology
- Diabetology
Background:
- End-stage renal disease (ESRD) patients on maintenance hemodialysis often have cardiovascular complications.
- Diabetes mellitus is a significant risk factor for cardiovascular disease in ESRD.
- The impact of diabetes on coronary artery dimensions and left ventricular function in ESRD patients requires further investigation.
Purpose of the Study:
- To investigate the role of diabetes mellitus in determining left ventricular function.
- To evaluate coronary artery diameter in patients with ESRD undergoing maintenance hemodialysis.
- To assess the relationship between diabetes, coronary artery dimensions, and left ventricular pressures.
Main Methods:
- A comparative study of 12 diabetic and 12 non-diabetic ESRD patients on maintenance hemodialysis.
- Echocardiography to measure left ventricular dimensions and wall thickness.
- Coronary angiography with computed densitometry to measure coronary artery diameter and assess calcification.
Main Results:
- Diabetic patients exhibited significantly smaller coronary artery diameters and a higher frequency of coronary artery calcification compared to non-diabetic patients.
- No significant differences were observed in left ventricular wall thickness, diameter, mean right atrial pressure, or cardiac index between the groups.
- Left ventricular end-diastolic pressure was significantly higher in diabetic patients (22 ± 9 mm Hg) than in non-diabetic patients (14 ± 5 mm Hg).
Conclusions:
- Diffuse luminal narrowing of epicardial coronary arteries in diabetic ESRD patients on hemodialysis is associated with increased left ventricular end-diastolic pressure.
- Diabetes mellitus contributes to coronary artery abnormalities in ESRD patients, impacting cardiac hemodynamics.
- These findings highlight the importance of managing diabetes to mitigate cardiovascular risk in ESRD patients on hemodialysis.
Background/Aims:
This study examined the role of diabetes mellitus on determining left ventricular function by evaluating coronary artery diameter in patients with end-stage renal disease on maintenance hemodialysis treatment.
Methods:
We studied 12 diabetic and 12 nondiabetic patients on maintenance hemodialysis treatment without significant stenoses of the major epicardial coronary arteries. Patients were matched for age, sex distribution, duration of dialysis and incidence of major coronary risk factors. Left ventricular wall thickness (septal and posterior walls) and left ventricular diameter (end-diastolic and systolic phases), were measured by echocardiography. Hemodynamic measurements and coronary angiography were performed on the day of hemodialysis and coronary artery diameter at the proximal and mid portion of three major coronary arteries were measured using the computed densitometry method.
Results:
Right and left anterior descending and circumflex coronary artery diameters were all significantly smaller and the frequency of coronary artery calcification was higher in diabetic (58%) compared to nondiabetic (8%) patients. Although there were no significant differences in left ventricular wall thickness, left ventricular diameter, mean right atrial pressure and cardiac index between the two groups, left ventricular end-diastolic pressure was significantly higher in diabetic (22 +/- 9 mm Hg) compared to nondiabetic patients (14 +/- 5 mm Hg).
Conclusion:
Despite that there were no significant stenoses of the major epicardial coronary arteries, diffuse luminal narrowing of the epicardial coronary arteries in diabetic patients on maintenance hemodialysis treatment was associated with increased left ventricular end-diastolic pressure.