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Left ventricular function in patients with chronic kidney disease evaluated by colour tissue Doppler velocity imaging
KTH, School of Technology and Health (STH), Medical Engineering.
Department of Clinical Physiology, Karolinska Institutet, Karolinska University Hospital.
Division of Baxter Novum, Department of Clinical Science, Karolinska University Hospital.
KTH, School of Technology and Health (STH), Medical Engineering.
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2006 (English)In: Nephrology, Dialysis and Transplantation, ISSN 0931-0509, E-ISSN 1460-2385, Vol. 21, no 1, 125-132 p.Article in journal (Refereed) Published
Abstract [en]

Background. Cardiovascular disease is the leading cause of death in chronic kidney disease (CKD) patients. Tissue Doppler velocity imaging (TVI) is a new objective method that accurately quantifies myocardial tissue velocities, deformation, time intervals and left ventricular (LV) filling pressure. In this study, TVI was compared with conventional echocardiography for the assessment of left ventricular (LV) function in pre-dialysis patients with different stages of CKD. The results obtained by TVI were used to analyse possible relationships between LV function and clinical factors such as hyperparathyroidism and hypertension that could influence LV function.

Methods. Conventional echocardiography and TVI images were recorded in 40 patients (36 men and 4 women, mean age 60 +/- 14 years, range 28-80 years) and in 27 healthy controls (21 men and 6 women, mean age 58 +/- 17 years, range 28-82 years). Twenty-two patients had mild/moderate CKD (CCr > 29 ml/min; Group 1) and 18 patients had severe CKD (CCr <= 29 ml/min; Group 2). Using TVI, the myocardial tissue velocities (v; cm/s) for isovolumetric contraction (IVCv), peak systole (PSv), early (E') and late (A') diastolic filling velocities as well as strain rate (SR), mitral annulus displacement, isovolumetric relaxation time (IVRT) and LV filling pressure were estimated using TVI. The average of six LV wall measurements was used to evaluate LV global function.

Results. Using TVI, we were able to identify significantly more patients with diastolic dysfunction than using conventional echocardiography (33 vs 26, P < 0.05). There was no difference in the prevalence of diastolic dysfunction between Group 1 and 2. However, using TVI, Group 2 CKD patients had lower E' velocities (6.2 +/- 1.9 vs 8.0 +/- 2.9 cm/s, P < 0.05) and higher IVRT (137.4 +/- 13 vs 88.2 +/- 26 ms, P < 0.001) in comparison with controls, indicating more accentuated diastolic dysfunction. Systolic blood pressure (SBP) was associated with E' velocities (rho = -0.68, P < 0.005) and E'/A' was strongly associated with SBP (rho = -0.60; P < 0.01) and PTH (rho = -0.64, P < 0.005) in Group 2. Using conventional echocardiography, there was no difference in the prevalence of systolic and diastolic dysfunction between patients with and without LVH. However, using TVI, patients with LVH had significantly lower IVCv (2.8 +/- 1.3 vs 3.8 +/- 1.5 and 3.8 +/- 1.5 cm/s, P < 0.05) and PSv (5.5 +/- 1.0 vs 6.3 +/- 1.2 and 6.4 +/- 1.3 cm/s, P < 0.05) compared with patients without LVH and controls, and they also had lower E' velocities (7.1 +/- 2.7 vs 8.0 +/- 2.9 cm/s, P < 0.05) compared with controls, indicating disturbances in systolic and diastolic left ventricular function.

Conclusions. TVI provided additional information on left ventricular function in CKD patients. In patients with advanced renal failure, TVI revealed more accentuated diastolic dysfunction associated with increased systolic blood pressure (SBP) and increased levels of PTH. TVI also demonstrated disturbances in contractility and contraction in patients with LVH, which could not be detected by conventional echocardiography.

Place, publisher, year, edition, pages
2006. Vol. 21, no 1, 125-132 p.
Keyword [en]
chronic kidney disease; parathyroid hormone; predialysis; tissue Doppler echocardiography
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:kth:diva-8353DOI: 10.1093/ndt/gfi075ISI: 000234436100026Scopus ID: 2-s2.0-30344456711OAI: oai:DiVA.org:kth-8353DiVA: diva2:13652
Note
QC 20100809Available from: 2008-05-07 Created: 2008-05-07 Last updated: 2012-03-23Bibliographically approved
In thesis
1. Evaluation of Myocardial Function in Chronic Kidney Disease: A Colour Tissue Velocity Imaging Study
Open this publication in new window or tab >>Evaluation of Myocardial Function in Chronic Kidney Disease: A Colour Tissue Velocity Imaging Study
2008 (English)Doctoral thesis, comprehensive summary (Other scientific)
Abstract [en]

In patients with chronic kidney disease (CKD), overhydration, uremic toxins and left ventricular (LV) dyssynchrony are factors that may lead to LV dysfunction and conduction abnormalities and thus contribute to the high cardiac mortality. Colour tissue velocity imaging (TVI) allows a detailed quantitative analysis of cardiac function in CKD patients, opening new possibilities to evaluate longitudinal myocardial motion, rapid isovolumetric events, LV filling pressure and LV synchronicity. Aims: Using TVI technique: 1. To evaluate myocardial function disturbances and their relations to risk factors in CKD patients. 2. To assess LV synchronicity in HD patients, both at baseline and after HD, and 3. To study acute cardiac effects of HD and i.v. furosemide in HD patients. Methods: 40 predialysis CKD (stages I, II, III, IV and V) (Study II) and 59 HD (Studies I, III, IV and V) patients were studied. In both groups of patients LV function was evaluated using TVI, and in HD patients LV synchronicity was also assessed using tissue synchronization imaging (TSI). In HD patients the evaluations were performed before and after HD (Studies III and V) and i.v. furosemide infusion (Study IV). Results: 1. TVI detected: a) LV contraction disturbances in CKD patients with LVH and normal ejection fraction. b) An increase of LV contractility after HD. c) No changes in cardiac function induced by furosemide. 2. TSI detected the presence of LV dyssynchrony and its improvement after HD. 3. In CKD, cardiac dysfunction seemed to be related to high levels of PTH, phosphate and blood pressure. Conclusions: TVI is a sensitive tool for studies on cardiac function in CKD, allowing a detailed and accurate evaluation of disturbances in LV function. TVI also provides the possibility to follow the changes in LV function and synchronicity induced by different therapeutical interventions. The obtained information may contribute to a better management of CKD patients.

Place, publisher, year, edition, pages
Stockholm: KTH, 2008. 104 p.
Series
Trita-STH : report, ISSN 1653-3836 ; 2008:3
Keyword
Cardiac, Kidney, Tissue, Velocity
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:kth:diva-4729 (URN)978-91-7178-894-8 (ISBN)
Public defence
2008-05-28, lecture hall, 3-221, Alfred Nobels Allé 10, Fleminsberg, Huddinge., Fleminsberg, Huddinge., 09:00
Opponent
Supervisors
Note
QC 20100809Available from: 2008-05-07 Created: 2008-05-07 Last updated: 2010-08-09Bibliographically approved

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