Acute changes in cardiac structural and tissue characterisation parameters following haemodialysis measured using cardiovascular magnetic resonance

Abstract

In patients with chronic kidney disease (CKD), reverse left ventricular (LV) remodelling, including reduction in LV mass, can be observed following long-term haemodialysis (HD) and has been attributed to regression of LV hypertrophy. However, LV mass can vary in response to changes in myocyte volume, edema, or fibrosis. The aims of this study were to investigate the acute changes in structural (myocardial mass and biventricular volumes) and tissue characterization parameters (native T1 and T2) following HD using cardiovascular magnetic resonance (CMR). Twenty-five stable HD patients underwent non-contrast CMR including volumetric assessment and native T1 and T2 mapping immediately pre- and post-HD. The mean time between the first and second scan was 9.1 ± 1.1 hours and mean time from completion of dialysis to the second scan was 3.5 ± 1.3 hours. Post-HD, there was reduction in LV mass (pre-dialysis 98.9 ± 36.9 g/m2 vs post-dialysis 93.3 ± 35.8 g/m2, p = 0.003), which correlated with change in body weight (r = 0.717, p < 0.001). Both native T1 and T2 reduced significantly following HD (Native T1: pre-dialysis 1085 ± 43 ms, post-dialysis 1072 ± 43 ms; T2: pre-dialysis 53.3 ± 3.0 ms, post-dialysis 51.8 ± 3.1 ms, both p < 0.05). These changes presumably reflect acute reduction in myocardial water content rather than regression of LV hypertrophy. CMR with multiparametric mapping is a promising tool to assess the cardiac changes associated with HD.

The reliability and feasibility of non-contrast adenosine stress cardiovascular magnetic resonance T1 mapping in patients on haemodialysis

“…ΔT1 was significantly lower in patients with coronary artery disease; diabetes mellitus compared to patients without these pathologies. Patient who previously had a kidney transplant displayed significantly higher ΔT1 compared to patients who had only been on dialysis found a statistically significant difference, the absolute mean change in native T1 was only 13 ms, representing approximately a 1% change [38].…”

Cardiac biomarkers in chronic kidney disease are independently associated with myocardial edema and diffuse fibrosis by cardiovascular magnetic resonance

“…Several studies revealed higher native T1 values in CKD patients [ 11 ], whereas more recently, a correlation of native T1 and troponin has also been shown [ 12 ]. A single previous study revealed raised T1 and T2 markers in participants with severe CKD on hemodialysis [ 13 ]. Native T1 of non-scarred myocardium is a strong predictor of survival, CVD mortality and incidence of HF in ischemic and non-ischemic cardiac conditions [ 14 , 15 ].…”

Aortic Stiffness and Heart Failure in Chronic Kidney Disease

“…The relation between native T1 and markers of adverse LV remodeling in CKD supports the thesis that the mechanism of cardiac dysfunction in CKD is not a consequence of potential ischemic heart disease, but results from the diffuse non-ischemic myocardial changes. The findings from these studies underline also the importance of performing CMR scans at the same timepoint in the weekly dialysis schedule when tracking longer-term changes [40].…”

“…Good correlation between change in indexed LV mass and change in body weight was found. Interestingly, significant improvement in systolic function was observed post-hemodialysis in a group of patients with impaired LV function (LVEF < 45%) [40]. These findings reflect the effect of reduction in myocardial water content following hemodialysis.…”

“…There was no significant correlation between change in native T1 values and change in body weight of hemodialysis patients, who underwent repeated CMR scan at a fixed interval from dialysis [39•]. However, another study showed changes in native T1 and native T2 in patients who underwent pre-and post-dialysis CMR scans at short intervals [40]. The mean time between the first and second CMR scan was 9.1 ± 1.1 h, and mean time from completion of dialysis to the second scan was 3.5 ± 1.3 h. Both native T1 and native T2, as well as indexed LV mass, were significantly lower post-hemodialysis.…”