Aortic Arch Calcification and Arterial Stiffness are Independent Factors for Diastolic Left Ventricular Dysfunction in Chronic Hemodialysis Patients

Abstract

Background Because cardiovascular disease is the major cause of death in dialysis patients, the correlation between diastolic left ventricular (LV) dysfunction and arterial sclerosis, including thoracic aortic calcification, was studied in chronic hemodialysis (HD) patients. Methods and ResultsThe enrolled study subjects were 142 (73 men, 69 women) maintenance HD patients. Aortic arch calcification volume (AoACV) was measured by MDCT scan, arterial stiffness was estimated by brachial -ankle pulse wave velocity (PWV) and diastolic LV function was estimated as E/E' by tissue Doppler imaging with cardiac ultrasonography. E/E' correlated significantly with systolic blood pressure (r=0.29, p=0.037), age (r=0.19, p=0.02), LV mass index (r=0.18, p=0.036), dialysis vintage (r=0.19, p=0.037), AoACV (r=0.37, p<0.0001) and PWV (r=0.33, p=0.0002). Multiple regression analysis indicated that AoACV ( =0.26, p=0.005) and PWV ( =0.22, p=0.03) were independent determinants of E/E'. Conclusion Diastolic LV dysfunction may be induced by increased vascular calcification and reduced arterial stiffness in chronic HD patients. (Circ J 2008; 72: 1768 -1772

Serum Fibroblast Growth Factor-23 Levels and Progression of Aortic Arch Calcification in Non-Diabetic Patients on Chronic Hemodialysis

“…Vascular calcifications were observed in 55.7% of patients and related to left ventricular hypertrophy, diastolic dysfunction, cardiac valve calcification, ischemic heart disease and cardiac failure episodes. We also reported that the extent of AoAC and arterial stiffness were independent determinants of left ventricular diastolic function in chronic HD patients 26) . In the present study, the serum FGF-23 level was shown to be a significant predictor of Ca and P metabolism in chronic HD patients without diabetes.…”

The balance of fetuin-A and osteoprotegerin is independently associated with diastolic dysfunction in hemodialysis patients

“…4 Previous reports have demonstrated that marked vascular calcification and stiffness predisposed hemodialysis patients to LVH and cardiac diastolic dysfunction. 21 We investigated the impact of fetuin-A and OPG serum levels, which are representative of potent vascular calcification regulators, on vascular stiffness and ventricular function. In hemodialysis patients, the levels of serum fetuin-A have been shown to be consistently low, probably due to its enhanced consumption 7 caused by the calcium phosphate load in addition to a chronic microinflammatory status.…”

Association Between Fibroblast Growth Factor 23 and Left Ventricular Hypertrophy in Maintenance Hemodialysis Patients - Comparison With B-Type Natriuretic Peptide and Cardiac Troponin T -

“…6,28 Thus, we assume that FGF-23 is likely to correlate with LVH that is induced directly by hyperphosphatemia or indirectly via hyperphosphatemia-induced vascular calcification, which induces diastolic dysfunction in patients with chronic HD. 29 Further study is necessary to test these possibilities. In addition, a study to investigate whether the combination of the FGF-23 and BNP improves the prediction of mortality compared with FGF-23 alone is warranted.…”