Myocardial fibrosis and diastolic dysfunction in patients on chronic haemodialysis

Losi, Maria Angela; Memoli, Bruno; Contaldi, Carla; Barbati, G.; Prete, Marco Del; Betocchi, Sandro; Cavallaro, Massimo; Carpinella, Gerardo; Fundaliotis, Angelica; Parrella, Lucia; Parisi, Valentina; Guida, Bruna; Chiariello, Massimo

doi:10.1093/ndt/gfp747

Cited by 45 publications

(40 citation statements)

References 29 publications

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“…However, attempting to maintain the EOAI at more than 0.85 may have contributed to the good operative results. In most dialysis patients, diastolic function is impaired because of hypertrophied myocardium, myocardial fibrosis, and other toxic effects caused by hypertension, increased volume, and hyperparathyroidism [20,21]. Therefore, a higher EOAI in dialysis patients than that in nondialysis patients might be required for effective left ventricular remodeling.…”

Section: Discussionmentioning

confidence: 99%

Aortic valve prosthesis selection in dialysis patients based on the patient’s condition

et al. 2012

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Previous studies have examined outcomes in dialysis patients undergoing cardiac surgery. However, only a few studies have solely focused on outcomes after aortic valve replacement (AVR). This study aimed to clarify independent predictors of the long-term survival of dialysis patients with AVR and to determine whether a mechanical valve or bioprosthesis is suitable based on the patient's condition. A total of 38 consecutive dialysis patients who underwent AVR at our institute were reviewed (mean age 69.1 ± 9.4 years). There were 23 bioprostheses and 15 mechanical valve replacements. The operative mortality and the long-term survival were not different between the bioprosthesis and the mechanical valve group (13.0 vs. 13.3%). The significant multivariate predictors for long-term survival were concomitant coronary artery bypass grafting (CABG) and prosthesis size. Valve types and age at operation did not affect long-term survival. Five-year survival of patients with small prosthetic valves and concomitant CABG was 0%. When the patient's quality of life is taken into account, it may be appropriate to use a bioprosthesis in a dialysis patient with a small annulus and concomitant CABG even if the patient is young.

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Section: Discussionmentioning

confidence: 99%

Aortic valve prosthesis selection in dialysis patients based on the patient’s condition

et al. 2012

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“…25,33, 34 Losi et al showed that myocardial fibrosis assessed using integrated backscatter signal but not LV mass index was independently associated with the presence of pseudonormal and restrictive patterns in 25 patients with ESRD undergoing HD. 5 This may suggest that LV fibrosis plays a central role in the development of LV diastolic dysfunction and the elevation of LV filling pressure in patients with ESRD on chronic HD. Importantly, MAC has been shown to affect mitral annular velocity and therefore may influence the assessment of a causal relationship between aortic valve narrowing and E/E'.…”

Section: Factors Of E/e'mentioning

confidence: 99%

Echocardiographic Assessment of Cardiac Structural and Functional Abnormalities in Patients With End-Stage Renal Disease Receiving Chronic Hemodialysis

Matsuo

Dohi

Makino³

et al. 2018

Circ J

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lead to a high rate of cardiovascular mortality. In particular, multiple pathways including calcium and phosphorus metabolic abnormalities caused by secondary hyperparathyroidism, inflammation and cardiac overload accelerate the process of valvular calcification, and the consequent P atients with end-stage renal disease (ESRD) on chronic hemodialysis (HD) often have a high prevalence of structural abnormalities of the heart including calcified valvular sclerosis, 1,2 left ventricular (LV) remodeling 3,4 and LV diastolic dysfunction, 5 which may

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“…We did not measure fibrosis; we used DD as a surrogate marker of myocardial fibrosis, which however correlates with fibrosis [44][45][46] . Fibrosis could be assessed with cardiac magnetic resonance, but the use of gadolinium in patients on dialysis is contraindicated.…”

Section: Discussionmentioning

confidence: 99%

High Prevalence of Diastolic Dysfunction in Incident Patients on Peritoneal Dialysis: Association with Low Thyroid Hormones

Sánchez

Paniagua²,

Prado³

et al. 2016

Nephron

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Background/Aims: Diastolic dysfunction (DD) and low levels of thyroid hormones (TH) are frequent found in chronic kidney disease; both are associated with all-cause and cardiovascular mortality. However, a link between them has not yet been established. The aim of this study was to analyze DD as a surrogate marker of fibrosis and its association with TH in incident patients on peritoneal dialysis (PD). Methods: A cross-sectional study with 183 incident patients on PD with preserved ejection fraction was performed. Clinical and demographic data were registered. Serum total and free (t/f) triiodothyronine (T3), thyroxin (T4), and thyroid stimulating hormone levels were determined by RIA kits, albumin and high-sensitivity C-reactive protein by conventional assays. Transthoracic 2D echocardiogram was performed for evaluation of left ventricular (LV) mass and ejection fraction. DD was evaluated using pulsed-wave tissue Doppler imaging. Results: Patients were 43 ± 12, 42% with diabetes mellitus (DM). Some degree of DD was found in 62% of patients; 18% had grade I DD, 8% grade II DD and 36% grade III DD. Patients with grade III DD were more likely to have diabetes, older, high LV mass and low serum albumin, t/fT3 and tT4 levels. In logistic multivariate regression analysis, it was found that diabetes (B = -0.86, 95% CI 0.182-0.992, p < 0.05), hypertension (B = -0.95, 95% CI 0.184-0.817, p = 0.01) and tT3 (B = -1.94, 95% CI 0.023-0.876, p < 0.05) were associated with grade III DD. Conclusions: High prevalence of grade III DD was found in incident patients on PD. In addition to DM and hypertension, tT3 was found to be an independent risk factor for grade III DD and more studies are needed to understand the reasons as to why this association is present.

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Myocardial fibrosis and diastolic dysfunction in patients on chronic haemodialysis

Abstract: Our data support the hypothesis that, in a selected population of patients with ESRD undergoing haemodialysis, myocardial fibrosis is associated with LV diastolic myocardial properties.

Cited by 45 publications

References 29 publications

Aortic valve prosthesis selection in dialysis patients based on the patient’s condition

Aortic valve prosthesis selection in dialysis patients based on the patient’s condition

Echocardiographic Assessment of Cardiac Structural and Functional Abnormalities in Patients With End-Stage Renal Disease Receiving Chronic Hemodialysis

High Prevalence of Diastolic Dysfunction in Incident Patients on Peritoneal Dialysis: Association with Low Thyroid Hormones

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