Left ventricular morphology and diastolic function in uraemia: echocardiographic evidence of a specific cardiomyopathy.

Facchin, L; Vescovo, G; Levedianos, Giorgio; Zannini, L.; Nordio, Maurizio; Lorenzi, S.; Caturelli, G; Ambrosio, Giovanni B.

doi:10.1136/hrt.74.2.174

Cited by 31 publications

(18 citation statements)

References 28 publications

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“…This hypothesis would need to be tested with adequate range designed study. Surprisingly, being consistent with Facchin et al (17), most of diastolic parameters were not related to blood pressure. Explanation can be an impact of many factors (except those mentioned in the upper part of discussion, age, heart rate, circulating volume and others) to evaluate diastolic parameters.…”

Section: Discussionsupporting

confidence: 91%

Blood pressure impact on left ventricular geometry in chronic haemodialysis patients

Bobocka¹,

Dúbrava²,

Slezák³

et al. 2013

BLL

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Abstract:Aim: Left ventricular hypertrophy in chronic haemodialysis patients is multifactorial. Our aim was to evaluate retrospectively the relationship between 24-h blood pressure monitoring and geometry and function of left ventricle (LV). Patients a methods:We examined 50 patients (men/women 33/17) treated by chronic haemodialysis (>3 months) aged 57.5 years (53-63; median, interquartile range). We measured blood pressure during 24 hours in short interdialytic period using Spacelab monitor 90217. Echocardiography was provided in short interdialytic period. Results: Left ventricular mass index signifi cantly correlated with SBP (tau-b=0.21; p=0.030; 95%CI 0.01-0.42), p=0.018; p=0.009;. SBP, DBP, MAP and PP did add a signifi cant information to the prediction of relative wall thickness. We did not fi nd any relationship between BP and left ventricular ejection fraction, left ventricular enddiastolic diameter and left atrial size. Conclusion:We found out an important 24-hour blood pressure impact on left ventricular relative wall thickness and left ventricular mass index. Left ventricular ejection fraction, left ventricular enddiastolic diameter and left atrial size were not related to 24-hour blood pressure. We did not fi nd a relationship between blood pressure and left ventricular enddiastolic diameter. From all diastolic parameters the strongest association was found between systolic blood pressure in all three phases and ratio of peak early to late diastolic fi lling velocity (Tab. 5, Ref. 19 Cardiovascular complications of haemodialysis treatment are the most common cause of increased morbidity and mortality among these patients (1). Already stage 3 chronic kidney disease patients with glomerular fi ltration rate <60 ml/min/1.73m 2 belongs to the high cardiovascular risk group (2). Echocardiography verifi ed left ventricular concentric or excentric hypertrophy is present at the beginning of haemodialysis treatment in 50-75 %, while during the next course the amount is further increasing (3). Uremic cardiomyopathy is a term used in connection with disturbed left ventricular morphology and funtion in renal failure. It is a myocardial dysfunction, which occured due to long lasting impact of hemodynamic and non-hemodynamic, with uraemia and dialysis associated risk factors. Arterial hypertension, volume overload, anaemia, uremic toxins, hyperparathyroidism and increased sympathetic activity belong to the most dominant risk factors (4). A strong relationship between left ventricular (LV) mass and blood pressure was shown also in a non-uraemic population. To confi rm this relationship in haemodialysis patients is more diffi cult due to many factors affecting LV mass. Blood pressure values obtained by ambulatory or home blood pressure monitoring provide more prognostic information on cardiovascular risk compared to blood pressure values measured during haemodialysis (5, 6).Aim of the retrospective study was to evaluate the impact of blood pressure measured by 24-hour ambulatory blood pressure monitoring (24-h A...

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Section: Discussionsupporting

confidence: 91%

Blood pressure impact on left ventricular geometry in chronic haemodialysis patients

Bobocka¹,

Dúbrava²,

Slezák³

et al. 2013

BLL

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“…[26][27][28][29] However, others could not confirm these findings and indicated that abnormalities in diastolic filling may occur early and before LVH and systolic dysfunction. [4,7] We did not find a significant correlation between LVMI and the E/A ratio, which was consistent with some reports in literature.…”

Section: Discussionmentioning

confidence: 74%

An Echocardiographic Assessment of Cardiac Functions and Structure in Children on Dialysis

et al. 2008

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“…This goes together with many previous studies [13][14][15][16]. Although it is well established that relaxation is impaired in the hypertrophied myocardium [25], in CRF diastolic function does not necessarily correlate with the degree of LVH [15,16].…”

Section: Discussionmentioning

confidence: 90%

“…Although many studies suggest that cardiac systolic [9][10][11][12][13] and diastolic [13][14][15][16] function may be impaired in patients with CRF, it is still highly controversial if correction of the secondary hyperparathyroidism associated with CRF can improve left ventricular (LV) function. Some authors have reported an improvement in LV systolic function after parathyroidectomy [12,17] or vitamin D therapy [18], while several others [18][19][20] have failed to demonstrate improvement after parathyroidectomy.…”

Section: Introductionmentioning

confidence: 99%

Effect of Intravenous Calcitriol on Cardiac Systolic and Diastolic Function in Patients on Hemodialysis

et al. 1998

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The systolic and diastolic function of the heart of hemodialysis (HD) patients and the effect of intravenous vitamin D therapy on cardiac function was studied by Doppler and digitized M-mode echocardiography in 10 HD patients before and after 3–4.5 months of calcitriol therapy. Calcitriol was administered intravenously 1–3 times a week at a dose of 1–2 µg after the dialysis sessions. Ten age- and sex-matched healthy controls were also examined echocardiographically. Before calcitriol therapy cardiac wall thicknesses (interventricular septum, posterior wall) and left ventricle (LV) dimensions (end diastolic, end systolic) were greater, and LV diastolic (peak late diastolic velocity, peak early diastolic velocity/peak late diastolic velocity ratio, isovolumic relaxation time) and systolic (fractional shortening) function was impaired in HD patients as compared to controls. The LV posterior wall thickness was related to plasma parathyroid hormone (PTH; r = 0.70, p = 0.01) in the patients. Calcitriol therapy raised serum ionized Ca from 1.23±0.04 to 1.33 ± 0.04 mmol/l and reduced PTH from 41.1±10.7 to 34.2±11.7 pmol/l (29±11%). Calcitriol therapy did not cause any significant changes in cardiac function in the whole patient group. However, in a subgroup of 5 patients with severe but controllable hyperparathyroidism (PTH >3 times upper normal margin) the LV dimensions and systolic function improved (LV end systolic dimension from 39.0 ± 4.0 to 31.3 ± 2.9 mm, p = 0.03; LV end diastolic dimension from 57.7 ± 3.1 to 53.4 ± 3.0 mm, p = 0.06; fractional shortening from 33 ± 4 to 42 ± 3%, p = 0.03). The diastolic indices improved also, but not significantly. In conclusion, left ventricle hypertrophy and systolic and diastolic dysfunction was observed in HD patients. Intravenous calcitriol therapy improved cardiac function in patients with severe secondary hyperparathyroidism.

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Left ventricular morphology and diastolic function in uraemia: echocardiographic evidence of a specific cardiomyopathy.

Cited by 31 publications

References 28 publications

Blood pressure impact on left ventricular geometry in chronic haemodialysis patients

Blood pressure impact on left ventricular geometry in chronic haemodialysis patients

An Echocardiographic Assessment of Cardiac Functions and Structure in Children on Dialysis

Effect of Intravenous Calcitriol on Cardiac Systolic and Diastolic Function in Patients on Hemodialysis

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