The Management of Coronary Artery Disease in Patients with End-Stage Renal Disease

Rutsky, Edwin A.; Rostand, Stephen G.

doi:10.1007/978-1-4615-3902-5_15

Cited by 8 publications

(5 citation statements)

References 75 publications

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“…An important functional role of intramyocardial arteriolar wall thickening was suggested by Rostand et al (17,18) and Rutsky and Rostand (19), who demonstrated that in 30% of uremic patients with angina pectoris, no narrowing of the epicardial conduit arteries was noted on coronarography. In addition, wall thickening of large arteries, i.e., A. carotis, and of the aorta was documented in patients with chronic renal failure (7)(8)(9)20).…”

mentioning

confidence: 92%

Hypertrophy of Intramyocardial Arteriolar Smooth Muscle Cells in Experimental Renal Failure

Törnig¹,

Gross²,

Simonaviciene³

et al. 1999

Journal of the American Society of Nephrology

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Abstract. Wall thickening of intramyocardial arteries in patients with chronic renal failure may contribute to the increased susceptibility of the uremic heart to ischemic injury. In this context, the following questions arise: (1) Is intramyocardial wall thickening in experimental renal failure due to hypertrophy, hyperplasia or both? (2) Which stimuli trigger wall thickening? Using novel stereologic techniques (Nucleator, Selector), intramyocardial arteries were examined in sham-operated and subtotally nephrectomized (SNX) Sprague Dawley rats with moderate renal failure of 8 wk duration. Systolic BP during the experiment was not significantly different in both groups. Absolute and relative left ventricular weight, wall thickness (5.69 ± 1.11 μm versus 4.42 ± 0.99 μm), and wall-to-lumen ratio of intramyocardial arteries (0.117 ± 0.03 μm/μm versus 0.089 ± 0.01 μm/μm) were significantly greater in SNX than in sham-operated rats. The mean cell and nuclear volume of intramyocardial arteriolar smooth muscle cells was significantly increased in SNX rats (650 ± 230 μm3versus 430 ± 90 μm3 and 26 ± 4.5 versus 19.9 ± 2.2 μm3, respectively). In parallel, the total arteriolar wall volume was significantly greater in the left ventricle of SNX (+ 58%) compared with sham rats. In contrast, the total length of all left ventricular arteries was comparable in both groups. The increase in mean cell volume without significant change in cell number indicates that arteriolar wall thickening in the heart of SNX rats is explained by hypertrophy rather than hyperplasia of arterial smooth muscle cells. This finding in a nonhypertensive experimental model of chronic renal failure contrasts with findings in spontaneously hypertensive rats. Independent of BP and left ventricular hypertrophy, specific growth signals must act on cardiac arteriolar smooth muscle cells.

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mentioning

confidence: 92%

Hypertrophy of Intramyocardial Arteriolar Smooth Muscle Cells in Experimental Renal Failure

Törnig¹,

Gross²,

Simonaviciene³

et al. 1999

Journal of the American Society of Nephrology

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“…the method appears to be a reliable param eter for myocardial ischemia as are serial measurements of CK. CK-MB and LDH isoenzymes [23]. Exercise stress testing has its diagnostic limitations by the frequent inability of dialysis patients to reach the target pulse-pres sure product due to joint problems, myopathy, polyneuro pathy and chronic anemia (table 2).…”

Section: Electrocardiogram (Ecg)mentioning

confidence: 99%

“…The same is true for the treatment of stable angina pectoris. Organic nitrates, 13-blockers and calcium channel blockers appear to be effec tive [23], We prefer (3-blockers because of their efficacy and their proven beneficial effect on improving cardio vascular prognosis.…”

Section: Medical Therapymentioning

confidence: 99%

“…Of course, clinical evaluation of potential coronary risk factors such as age, sex, smoking, lipids, blood pres sure profile and comorbidity is helpful in preselecting Coronary A rtery Disease in Dialysis Patients patients for angiography. Several algorithms in diabetic [15] and nondiabetic ESRD patients [23] have been pro posed to select primarily those dialysis patients in whom the likelihood of CAD is low and angiography can be avoided.…”

Section: Coronary a Ngiographymentioning

confidence: 99%

“…Given the limitations of exercise testing in ESRD patients, where 80% so tested failed to achieve their target heart rate of 85% of maximal capacity [23], intravenous infusion of the vasodilator dipyridamole was used as a substitute for ergometer stress. However, due to frequent intramyocardial vessel disease, it appears that thallium-201 scans in dialysis patients are excellent predictors of future cardiovascular events but lack of specificity limits its reliability in establishing a diagnosis of CAD [24][25][26][27], Thus, the method has an established place in the pretrans plant assessment of dialysis patients and -due to its noninvasive character and prognostic power -in the follow up of CAD patients with angiographically confirmed dis ease.…”

Section: Thallium-201 Myocardial Imagingmentioning

confidence: 99%

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Coronary Artery Disease in Dialysis Patients

Wizemann¹

1996

Nephron

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Coronary artery disease is a frequent condition in dialysis patients and – probably due to the atypical symptomatology – is frequently underdiagnosed. Non-invasive tests are of limited value in establishing diagnosis, whereby arteriography is frequently necessary. Secondary prophylaxis is the same as in nondialysis patients. Due to a high reocclusion rate following PTCA bypass grafting is the preferred therapeutical option. When medical therapy is indicated, hemodialysis therapy should be adapted to coexistent coronary artery disease by avoiding dialysis hypotension and overhydration. In coronary patients renal anemia worsens coronary perfusions and should be treated targeting at least a hematocrit of 35 %.

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Creatine kinase-MB fraction elevation after percutaneous coronary intervention in patients with chronic renal failure

Gruberg

Mehran

Waksman

et al. 2001

The American Journal of Cardiology

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The Management of Coronary Artery Disease in Patients with End-Stage Renal Disease

Cited by 8 publications

References 75 publications

Hypertrophy of Intramyocardial Arteriolar Smooth Muscle Cells in Experimental Renal Failure

Hypertrophy of Intramyocardial Arteriolar Smooth Muscle Cells in Experimental Renal Failure

Coronary Artery Disease in Dialysis Patients

Creatine kinase-MB fraction elevation after percutaneous coronary intervention in patients with chronic renal failure

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