Aortic stiffness and valvular calcifications in patients with end-stage renal disease

Abstract

Objectives. To evaluate the presence and extent of cardiac calcifications and aortic stiffness in patients with end-stage renal disease (ESRD). Patients and methods. The study group consisted of 60 patients with ESRD with a mean age of 51.7 years, treated with peritoneal dialysis. In all patients transthoracic echocardiogram was performed to assess the following parameters: left ventricular end-systolic diameter, left ventricular end-diastolic diameter (LVEDd), interventricular septum end-diastolic diameter (IVSDd), posterior wall end-diastolic diameter (PWDd), ejection fraction (EF), fractional shortening (FS), aortic maximal and minimal diameter, aortic valve area, mitral valve area (MVA), left ventricular ejection time (LVET), maximal aortic velocity. Aortic stiffness index (AS) was calculated. Aortic and mitral valve calcifications were assessed. Results. Patients with ESRD had a larger left ventricle (LVEDd 5.4 cm vs. 4.76 cm) and its wall was thicker (IVSDd 1.36 cm vs. 1.02 cm; PWDd 1.31 cm vs. 0.94 cm). Patients had poorer left ventricle contractility (EF 56.1 vs. 61.6%; FS 28.5 vs. 33.2%). Atherosclerotic plaques, calcified plaques and valvular calcifications were more frequently detected in patients with ESRD. Patients with ESRD had significantly higher values of the AS index: (5.34 vs. 3.24). Among ESRD subjects with the stiffer aorta, atherosclerotic plaques including calcificones and the aortic valve damage were more frequently detected. Conclusions. Patients with ESRD are characterized by increased aortic stiffness. Atherosclerotic plaques in the aorta as well as cardiac and large vessels calcifications are more common among patients with ESRD. In patients with ESRD there is a correlation between an increase in aortic stiffness and damage of aortic valvular leaflets as well as calcifications of atherosclerotic plaques in the aorta. The degree of aortic stiffness is not related to impairment of mitral valvular leaflets and extravalvular calcifications. A relationship between aortic stiffness and aortic or aortic valve calcifications suggest a different pathogenesis of aorta calcification as compared to that underlying calcifications of other localizations.

Risk Estimation of Aortic Stiffness in Patients with End Stage Renal Disease on Maintenance Haemodialysis

“…This case-control study was carried out with an aim to estimate the frequency of aortic stiffness among CKD-5(D) population and to compare these complications between CKD-5(D) population and non-CKD population.In this current study it was observed that Mean (±SD) age of the ESRD patients were 50.64±14.26 (range 20.0 76.0). Panuccio et al 8 in Italy and Zapolski1 et al 9 in Poland showed the mean age of ESRD patients were 59±15 years and 51.7±7.1 years respectively, which are higher than the current study. This may be due to increased life expectancy including entry of more aged patients in dialysis and long duration of dialysis in their country.…”

Does Vascular Calcification Correlate with Pulse Wave Velocity in Hemodialysis Patients?

“…[39][40][41] As a consequence, both the National Kidney Foundation and the American Heart Association have stated that CKD-5 patients should be considered at the highest risk for cardiovascular disease. [39][40][41] Although many traditional risk factors play an important role, several non-traditional factors, such as alteration of bone and mineral metabolism and a heightened oxidative and inflammatory state and cardiovascular calcification, appear to contribute substantially to the increased risk. 16,[42][43][44][45][46][47][48][49] The severity of vascular and valvular calcification has been assessed by plain radiography, ultrasonography, echocardiography and, most recently, cardiac computed tomography.…”

Assessment of aortic stiffness, myocardial performance index and cardiac functions in patients with end-stage renal disease

“…Again, in a study by Zapolkski et al, it was seen that aortic stiffness, atherosclerotic plaques in aorta and large vessel calcification were increased in patients with ESRD. It was found that the degree of aortic stiffness wasn't related to calcification in mitral leaflets or extra-valvular calcification (13).…”