Silent Myocardial Ischemia and High-Grade Ventricular Arrhythmias in Patients on Maintenance Hemodialysis

Mohiuddin, Khalid; Bali, Harinder K.; Banerjee, Saurav; Sakhuja, Vinay; Jha, Vivekanand

doi:10.1081/jdi-200048236

Cited by 23 publications

(21 citation statements)

References 9 publications

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“…Silent myocardial ischemia, defined by asymptomatic dynamic ST-T changes suggestive of ischemia, has been repeatedly reported with a prevalence of 16–60% (68–72) . Interestingly, studies where coronary angiograms were performed found no correlation between silent ischemia and angiographic findings (69, 72) .…”

Section: Introductionmentioning

confidence: 99%

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Cardiovascular impact in patients undergoing maintenance hemodialysis: Clinical management considerations

Chirakarnjanakorn

Navaneethan

Francis

et al. 2017

International Journal of Cardiology

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Patients undergoing maintenance hemodialysis develop both structural and functional cardiovascular abnormalities. Despite improvement of dialysis technology, cardiovascular mortality of this population remains high. The pathophysiological mechanisms of these changes are complex and not well understood. It has been postulated that several non-traditional, uremic-related risk factors, especially the long-term uremic state, which may affect the cardiovascular system. There are many cardiovascular changes that occur in chronic kidney disease including left ventricular hypertrophy, myocardial fibrosis, microvascular disease, accelerated atherosclerosis and arteriosclerosis. These structural and functional changes in patients receiving chronic dialysis make them more susceptible to myocardial ischemia. Hemodialysis itself may adversely affect the cardiovascular system due to non-physiologic fluid removal, leading to hemodynamic instability and initiation of systemic inflammation. In the past decade there has been growing awareness that pathophysiological mechanisms cause cardiovascular dysfunction in patients on chronic dialysis, and there are now pharmacological and non-pharmacological therapies that may improve the poor quality of life and high mortality rate that these patients experience.

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Section: Introductionmentioning

confidence: 99%

“…Interestingly, studies where coronary angiograms were performed found no correlation between silent ischemia and angiographic findings (69, 72) . This may be explained by the existence of microcirculatory changes in the coronary system in ESRD.…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular impact in patients undergoing maintenance hemodialysis: Clinical management considerations

Chirakarnjanakorn

Navaneethan

Francis

et al. 2017

International Journal of Cardiology

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“…Consequently, the ECG has lower sensitivity for ischaemia diagnosis in this patient group [30]. Silent ischaemia and chest pain with unobstructed coronary arteries are common in renal failure [6,30,31]. Cardiac symptoms are thus less reliable for ischaemia diagnosis.…”

Section: Markers Of Ischaemia In Esrdmentioning

confidence: 95%

Evaluation of ischaemia-modified albumin as a marker of myocardial ischaemia in end-stage renal disease

et al. 2007

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The early diagnosis of myocardial ischaemia is problematic in patients with ESRD (end-stage renal disease). The aim of the present study was to determine whether IMA (ischaemia-modified albumin) increases during dobutamine stress and detects myocardial ischaemia in patients with ESRD. A total of 114 renal transplant candidates were studied prospectively, and all received DSE (dobutamine stress echocardiography). IMA levels were taken at baseline and 1 h after cessation of DSE. A total of 35 patients (31%) had a positive DSE result. Baseline IMA levels were not significantly different in the DSE-positive and -negative groups. The increase in IMA was significantly higher in the DSE-positive group compared with those with no ischaemic response (26.5 +/- 19.1 compared with 8.2 +/- 9.6 kU/l respectively; P = 0.007; where kU is kilo-units). From ROC (receiver operator charactertistic) curve analysis, the optimal IMA increase to predict an ischaemic response was 20 kU/l, with a sensitivity of 81% and a specificity of 72% [area under the curve, 0.80 (95% confidence interval, 0.44-0.94); P = 0.03]. There were 18 deaths, ten of which were cardiac in nature over a follow up period of 2.25 +/- 0.71 years. An increase in IMA > or = 20 kU/l was associated with significantly worse survival (P = 0.02). In conclusion, IMA is a moderately accurate marker of myocardial ischaemia in ESRD. Patients with an increase in IMA > or = 20 kU/l during DSE had significantly worse survival.

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“…The evidence of HD-induced myocardial ischemia came from electrocardiogram-based studies and isotopic perfusion imaging. Zuber et al demonstrated silent ST-depression occurring during hemodialysis [21] and its rates varied between 15 to 40% in next studies [22][23][24]. Singh et al observed the dialysis-induced myocardial perfusion defects in seven of ten patients, examined by single-photon emission computed tomography [25].…”

Section: Discussionmentioning

confidence: 99%

Wpływ stopnia nawodnienia oraz zmienności ciśnienia tętniczego krwi i częstości rytmu serca w czasie hemodializy na śróddializacyjne zmiany stężeń wysokoczułej troponiny T

Wajdlich

Podlejska²,

Rosół³

et al. 2017

Arterial Hypertension

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Effect of hydration status and variability of blood pressure and heart rate induced by hemodialysis on intradialytic changes of high sensitive troponin T Wpływ stopnia nawodnienia oraz zmienności ciśnienia tętniczego krwi i częstości rytmu serca w czasie hemodializy na śróddializacyjne zmiany stężeń wysokoczułej troponiny T AbstractIntroduction. High sensitivity troponin T (TnT-hs) is biomarker of myocardial damage and ischemia. Despite its elevation troponin still preserve its usefulness as a marker of the cardiovascular risk and mortality in chronic kidney disease. Variations of hydration status between and during hemodialysis exert significant hemodynamic effects, which may negatively affect cardiovascular system and blood pressure and lead to myocardial damage. The aim of the study was to access the effect of hydration status and variability of blood pressure and heart rate induced by hemodialysis on intradialytic changes of TnT-hs, in chronic hemodialysis patients. Material and methods. In 50 chronic hemodialysis patients (35M, 15F, mean age 64 ± 12 years) blood pressure and heart rate were monitored noninvasively during HD session. Serum concentration of TnT-hs and hydration status were assessed before and after hemodialysis.Results. TnT-hs concentration was above normal range in 98% patients before, and in all after hemodialysis. Median TnT-hs level was 82 ng/L before and 84 ng/L after hemodialysis, which comprised 586% and 600% of the upper limit of normal range. There was a small 2.4%, intradialytic increase of TnT-hs (p = 0.004). TnT-hs levels correlated positively with mean interdialytic weigh gain, before HD (r = 0.43, p = 0.02) and after HD (r = 0.5, p = 0.003).There was also a positive correlation between TnT-hs concentration and mean heart rate (r = 0.37, p = 0.008) and with mean systolic blood pressure during HD, before HD (r = 0.3, p = 0.026) and after HD (r = 0.3, p = 0.031). Conclusions. Hemodialysis can be a risk factor of myocardial injury, especially in overhydrated patients. Key words: hemodialysis, overhydration, troponin T, TnT-hs Arterial Hypertens. 2017, vol. 21, no. 4, pages: 186-194 DOI: 10.5603 StreszczenieWstęp. Wysokoczuła troponina T (TnT-hs) jest przydatnym klinicznie wskaźnikiem uszkodzenia komórek mięśnia sercowego. Stężenia TnT-hs u pacjentów z przewlekłą chorobą nerek są wyższe niż w populacji ogólnej, co wiąże się ze zwiększonym ryzykiem incydentów sercowo-naczyniowych oraz zgonu. Znaczne zmiany stopnia nawodnienia w czasie zabiegu hemodializy mogą niekorzystnie oddziaływać na układ sercowo-naczyniowy i ciśnienie tętnicze, co w efekcie może prowadzić do uszkodzenia kardiomiocytów. Celem pracy była ocena wpływu stanu nawodnienia, zmian częstości rytmu serca (HR) i ciśnienia tętniczego (BP) w trakcie hemodializy (HD) na zmiany stężeń TnT-hs powodowane zabiegiem hemodializy u pacjentów długotrwale hemodializowanych. Materiał i metody. U 50 pacjentów (35M, 15K, średnia wieku 64 ± 12 lat) z rozpoznaniem schyłkowej niewydolności nerek, długotrwale hemodializowanych, nieinwazy...

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Silent Myocardial Ischemia and High-Grade Ventricular Arrhythmias in Patients on Maintenance Hemodialysis

Cited by 23 publications

References 9 publications

Cardiovascular impact in patients undergoing maintenance hemodialysis: Clinical management considerations

Cardiovascular impact in patients undergoing maintenance hemodialysis: Clinical management considerations

Evaluation of ischaemia-modified albumin as a marker of myocardial ischaemia in end-stage renal disease

Wpływ stopnia nawodnienia oraz zmienności ciśnienia tętniczego krwi i częstości rytmu serca w czasie hemodializy na śróddializacyjne zmiany stężeń wysokoczułej troponiny T

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