Alteration of proximal aorta biophysical properties in patients with end stage renal disease

Abstract

Objective: To present a novel, non-invasive echocardiographic application to assess the structural and functional properties of the complex composition of the proximal aorta in patients with end stage renal disease (ESRD). Methods: 71 haemodialysis patients (mean (SD) age 61.3 (9.3) years, dialysis duration 79.2 (51.6) months) and 62 age matched controls were studied. From the suprasternal view, the distance between ascending and descending aorta was measured with two dimensional ultrasound. The aortic flow wave transit time was measured with pulsed wave Doppler. M mode echocardiography, with simultaneous blood pressure estimates, was used to assess the diameters of the aortic annulus and of the ascending aorta. Pulse pressure, pulse wave velocity (PWV), pressure strain elastic modulus, characteristic impedance, and b index were calculated. Results: Patients had increased pulse pressure (68.0 (7.2) v 51.4 (5.0) mm Hg, p , 0.001), PWV (6.1 (1.1) v 3.9 (0.6) m/s, p , 0.001), characteristic impedance (174 (58) v 111 (31) m/s?cm 2 , p , 0.001), pressure strain elastic modulus (872 (254) v 541 (140) mm Hg, p , 0.001), and b index (8.9 (3.4) v 5.5 (1.4), p , 0.001) compared with controls. In patients PWV was correlated with age and time on haemodialysis (r = 0.44, p , 0.001, and r = 0.51, p , 0.001, respectively). Conclusion: A novel application of duplex ultrasound of the proximal aorta showed that patients with ESRD have impaired proximal aortic function compared with controls. The data indicate that these noninvasive measurements can be used to describe status and change in aortic biophysical properties and may be used as a marker for cardiovascular disease risk.

Adiponectin and Cardiovascular Remodeling in End-Stage Renal Disease and Co-Morbid Diabetes Mellitus

“…Our results indicate that large arteries, the major site of CV complications, should be taken into consideration when assessing cardiovascular alterations in ESRD. In this study, aortic stiffness was assessed by means of PWVr, which provides information regarding functional and biophysical alterations in the proximal aorta [14]. It is of note that PWVr correlated significantly with LVMI in ESRD patients.…”

“…During the study period, all patients were ‘normotensive’ [predialysis blood pressure (BP) <140/90] and had achieved their ‘dry weight’ (defined asthe body weight below which a normal albuminemic patient experienceshypotension or muscle cramps and postural hypotension is clinicallymanifest) [13]. All patients were dialyzed via a fistula using techniques previously described [14]. All biochemical and cardiovascular measurementswere performed during the first 2 weeks on the morningbefore the midweek HD session.…”

“…Regional PWV of the proximal aorta (PWVr) was estimated as previously described [14]. Briefly, from the suprasternal view pulsed waves (PW)-Doppler tracings of the ascending and descending aorta were recorded within 10 s of each other at a sweep speed of 100 mm/s.…”

“…The following calculations were used: transit time (TT) = T2 – T1 and PWVr = AOL/TT (m/s). We used raw PWVr data, as we have demonstrated that PWVr isBP-independent in ESRD patients [14]. In thebaseline study of our cohort, the raw and BP-corrected PWVrvalues showed a tight correlation ( r = 0.963; p < 0.0001);the fitting line had a slope of 0.952 (95% CI: 0.921–0.973) and anintercept of 0.038 (95% CI: 0.022–0.051).…”

Androgen Deficiency and Endothelial Dysfunction in Men with End-Stage Kidney Disease Receiving Maintenance Hemodialysis

“…During the study period, all patients were ‘normotensive’ [predialysis blood pressure (BP) <140/90 mm Hg] and have achieved their ‘dry weight’ (defined as the body weight below which a normal albuminemic patient experiences hypotension or muscle cramps and postural hypotension is clinically manifest) [24]. All patients were dialyzed via a fistula using techniques previously described [25]. All biochemical and cardiovascular measurements were performed during the first 2 weeks on the morning before the midweek HD session.…”