Cardiac valve calcification is associated with presence and severity of coronary artery disease in patients with pre-dialysis chronic kidney disease

Kim, Il Young; Kim, Min Jung; Lee, Jun Young; Lee, Soo Bong; Shin, Min Ji; Rhee, Harin; Yang, Byeong Yun; Song, Sang Heon; Seong, Eun Young; Kwak, Ihm Soo

doi:10.1007/s10157-015-1104-4

Cited by 20 publications

(25 citation statements)

References 19 publications

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“…In our study, 2D-STE revealed a statistically signiﬁcant decline in GLS in patients on hemodialysis with VC compared with patients without VC, while circumferential function was not different. Systolic dysfunction may be initially apparent in the longitudinal direction, because subendocardial fibers more vulnerable to myocardial ischemia and fibrosis are longitudinally oriented [6]. LV concentric hypertrophy is mainly caused by hypertrophic response in the mid-myocardial layers, which are mainly more circumferentially oriented.…”

Section: Discussionmentioning

confidence: 99%

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Early Left Ventricular Dysfunction Detected by Speckle Tracking in Long-Term Hemodialysis Patients with Valvular Calcification

Li¹,

Li²,

Wang³

et al. 2018

Cardiorenal Med

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Purpose: Cardiac valve calcification (VC) is very common in patients on hemodialysis. However, the definite effect of VC on left ventricular (LV) geometry and function in this population is unknown, especially when LV ejection fraction (LVEF) is normal. The aim of this study was to determine the effect of VC on LV geometry and function in long-term hemodialysis patients by conventional echocardiography and two-dimensional speckle tracking echocardiography (2D-STE). Methods: A total of 47 hemodialysis patients (2–3 times weekly for 5 years or more) were enrolled in this study. Cardiac VC was defined as bright echoes of more than 1 mm on one or more cusps of the aortic valve or mitral valve or mitral annulus using echocardiography as the screening method. LV longitudinal global strain (GLS) was assessed on the apical four-chamber view and calculated as the mean strain of 6 segments. LV global circumferential strain was acquired on the LV short axis view at the level of papillary muscles. Results: Twenty-five patients with VC had higher mean values of interventricular septum thickness, LV posterior wall thickness, LV mass index, relative wall thickness, and LV mass/end-diastolic volume than 22 patients without VC (p < 0.05, respectively), indicating more obvious LV hypertrophy (LVH). VC patients had higher mitral annular E/E′ values, especially at the septal side representing increased LV filling pressure compatible with diastolic dysfunction, while only the E/E′ ratio of the septal side was significantly different between the 2 groups (16.7 ± 4.1 vs. 12.3 ± 4.4, p < 0.01). When assessed by GLS, LV longitudinal systolic function was also lower in in patients with VC compared with those without VC (–0.18 ± 0.03 vs. –0.25 ± 0.04; p < 0.01). Conclusions: Cardiac VC diagnosed by echocardiography when it occurs in long-term hemodialysis patients may indicate more severe LVH, myocardial damage, and worse heart function in comparison to those without VC. Tissue Doppler imaging and 2D-STE can detect the subtle change of heart function in this population in the early stage of LV dysfunction when LVEF is normal.

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Section: Discussionmentioning

confidence: 99%

“…Cardiac VC is also associated with the presence and severity of coronary artery diseases in chronic kidney diseases [3, 6]. Using echocardiography as the screening method, cardiac VC is a frequent complication with a prevalence of at least 30% in the ESRD patients [3].…”

Section: Introductionmentioning

confidence: 99%

Early Left Ventricular Dysfunction Detected by Speckle Tracking in Long-Term Hemodialysis Patients with Valvular Calcification

Li¹,

Li²,

Wang³

et al. 2018

Cardiorenal Med

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“…In HD patients, both vascular and valvular calcification are frequent, probably due to CKD‐MBD derangements, inflammation, and cardiac overload . In predialysis CKD, the presence of valvular calcification correlates with the presence and severity of coronary artery disease, as shown by Kim YI et al., suggesting that assessment of cardiac calcification by TTE could be a valuable risk‐stratification tool for CAD in these patients . In stable HD patients, valvular calcifications are associated with worse systolic and diastolic function, more severe LVH, and poorer prognostic …”

Section: Conventional Transthoracic Echocardiography (Tte)mentioning

confidence: 99%

Multi‐modality cardiac imaging in advanced chronic kidney disease

Ureche

Sascău

Țăpoi³

et al. 2019

Echocardiography

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Cardiovascular disease (CVD) is the leading cause of death worldwide and is particularly frequent among those with severe renal impairment. Early diagnosis and therapeutic intervention may help alleviate the burden of cardiovascular complication within this population. In the last years, advances have been made toward developing noninvasive imaging techniques that could offer better insight into the cardiac involvement in end‐stage renal disease (ESRD). Conventional transthoracic echocardiography remains the first‐line investigation used to assess cardiac function, but encompassing in our daily practice, the newer approaches such as speckle‐tracking imaging, cardiac computed tomography, or cardiac magnetic resonance can guide us to a more comprehensive understanding of CVD in ESRD. Given that patients with chronic kidney disease may not present with typical CVD symptoms, the amount of information brought by newer imaging techniques is crucial for an accurate diagnosis, risk stratification, and further management. The purpose of this review is to briefly summarize the specific applications of standard cardiac imaging techniques in patients with ESRD and to offer insight into the novel imaging modalities, highlighting the newest research in this field. By doing so, we aim to identify the most important imaging predictors of clinical outcomes in this population.

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“…Furthermore, we repeated the Agatston score in 88 cases at 1 year post-dialysis initiation. Cardiac valve calcification was evaluated based on the presence or absence of a calcified aortic valve and mitral valve [11].…”

Section: Calcification Measurementmentioning

confidence: 99%

Risk of cardiovascular mortality predicted by the serum calcium level and calcification score at the initiation of dialysis

Sato

Nagasawa²,

Saito

et al. 2018

Clin Exp Nephrol

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Background The relationship between serum corrected calcium (CCa) level and vessel calcification at dialysis initiation and survival has seldom been evaluated. Therefore, we evaluated the efficacy of CCa levels and the calcification score at the initiation of dialysis for predicting all-cause and cardiovascular (CV) mortality in patients with end-stage renal disease (ESRD). Methods The study group included 407 patients with ESRD, who started hemodialysis between January 2009 and December 2016 at the Red Cross Ishinomaki Hospital. The primary outcomes were the 1-and 3-year all-cause and CV mortality rate, with the association between CCa level and CVD-specific mortality evaluated using the Kaplan-Meier method and Cox proportional hazard regression analysis. Results Patients with a high initial CCa level were at higher risk for CVD-related, but not all-cause, mortality than patients with a low initial CCa level [hazard ratio (HR) 2.81; 95% confidence interval 1.05-7.55]. The HR for CVD-related mortality was also higher for patients with an Agatston vessel calcification score > 2000 (HR 13.9; 95% CI 1.63-118.2). Overall, the 3-year CVD-free rate was 88.2% (range 76.4-94.3%). Higher CCa level was associated with a higher Agatston score and cardiac valve calcification. Conclusion High serum CCa levels and an Agatston score > 2000 are independent risk factors of CVD mortality due to advanced vessel calcification.

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Cardiac valve calcification is associated with presence and severity of coronary artery disease in patients with pre-dialysis chronic kidney disease

Abstract: Cardiac valve calcification is associated with the presence and severity of CAD in pre-dialysis CKD. Assessment of cardiac valve calcification by means of transthoracic echocardiography could be a valuable non-invasive method for CAD risk stratification in pre-dialysis CKD patients.

Cited by 20 publications

References 19 publications

Early Left Ventricular Dysfunction Detected by Speckle Tracking in Long-Term Hemodialysis Patients with Valvular Calcification

Early Left Ventricular Dysfunction Detected by Speckle Tracking in Long-Term Hemodialysis Patients with Valvular Calcification

Multi‐modality cardiac imaging in advanced chronic kidney disease

Risk of cardiovascular mortality predicted by the serum calcium level and calcification score at the initiation of dialysis

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