Asymmetric Septal Hypertrophy in Uremic-Normotensive Patients on Regular Hemodialysis

Bernardi, Daniele; Bernini, L. F.; Cini, G; Geri, A; Urti, Donato Antonio; Bonechi, I

doi:10.1159/000183333

Cited by 20 publications

(6 citation statements)

References 17 publications

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“…2,3 Many investigators have reported that a significant number of dialysis patients may have the echocardiographic features of congestive cardiomyopathy, 19,[20][21][22][23] and that LV hypertrophy is common in these patients. [22][23][24][25][26][27] According to one report, more than half of all patients on maintenance hemodialysis without any apparent coronary artery disease, pericardial effusion, valvular heart disease, or heart failure, had abnormal left ventricular function, and the significant abnormalities were enlargement of the left ventricular cavity, a reduction of myocardial contractility, and thickening of the left ventricular posterior wall. 19 Furthermore, left ventricular hypertrophy has been identified as a major risk factor for cardiovascular mortality, [28][29][30] especially in the uremic population with hypertension.…”

Section: Discussionmentioning

confidence: 99%

Beneficial Effects of Renal Transplantation on Cardiovascular Disorders in Dialysis Patients

et al. 1998

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The present study was conducted to evaluate the impact of successful renal transplantation against the cardiovascular risk factors of patients on maintenance dialysis in whom cardiovascular accidents are the most common cause of death. A total of 74 renal transplant patients with grafts that had been functioning well for longer than 6 months after transplantation were examined before and 6-250 months after transplantation. The mean age was 34 years and the duration after transplantation was 104 +/- 66 months. An improvement in anemia from hemoglobin level of 9.0 to 13.6 g/dl and a decrease in mean systolic blood pressure from 157 +/- 24 to 135 +/- 14 mm Hg (P < 0.001) were observed after transplantation. An elevation in RV5 + SV1 levels by 0.6 mV on electrocardiogram (P = 0.042) was seen without any change in the cardiothorathic ratio on chest X-ray. Echocardiographic measurements of six recipients revealed great improvements in the left ventricular systolic dimension and thickness of the posterior wall of the left ventricle. Moreover, the ejection fraction and fractional shortening rose significantly from 59.4% +/- 16.3% to 75% +/- 8.1%, and from 30.6% +/- 9.2% to 44.8% +/- 7.9% (P = 0.017), respectively. These findings clearly show that successful renal transplantation can significantly improve the cardiovascular function of renal patients on maintenance dialysis.

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Section: Discussionmentioning

confidence: 99%

Beneficial Effects of Renal Transplantation on Cardiovascular Disorders in Dialysis Patients

et al. 1998

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“…Numerous studies define the morphologic and func tional cardiac status in ESRD [2,7,18,22,31], however, small selected or large unselected groups of ESRD pa tients make it difficult to attribute pathological findings to hemodialysis and distinguish the influence due to preceding or additional influences. Conflicting results can mainly be attributed to differing selection of patients, study design and choice of methods.…”

Section: Introductionmentioning

confidence: 99%

Analysis of Left-Ventricular Changes Associated with Chronic Hemodialysis

Hüting

Krämer

Schütterle

et al. 1988

Nephron

108

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To assess the reasons for the frequent cardiovascular complications in patients with end-stage renal disease (ESRD), 61 out of 131 normotensive ESRD patients originally examined (mean ESRD duration: 71 ± 41 months) were followed over 2.5 years by echo-, electro- and mechanocardiography. Clinical and biochemical parameters were comparable. The prevalence of pericardial effusion (3%), pericardial thickening (14%), aortic valve sclerosis (14%) and mitral valve anulus sclerosis (12%) was unchanged. The interventricular septum diameter (14.3 ± 3.0 vs. 16.4 ± 3.4 mm), index of left-ventricular (LV) wall asymmetry (1.25 ± 0.30 vs. 1.52 ± 0.36) and left atrial diameter (38.3 ± 5.4 vs. 42.6 ± 3 mm) increased (p < 0.001). The LV end-systolic diameter decreased slightly (35.8 + 6.3 vs. 34.2 ± 6.4 mm; p < 0.05), with no significant changes for end-diastolic diameter (50.4 ± 6.3 vs. 49.3 ± 6.1 mm), muscle mass index (189 ± 57 vs. 197 ± 50 g/m²), stroke volume (86.1 ± 26.2 vs. 85.7 ± 26.7 7 ml/m²) and fractional shortening (29.1 ± 7 vs. 30.8 ± 8.6%). We conclude that the predominant finding in ESRD is an LV hypertrophy progressing towards an asymmetric septum hypertrophy, while the increase of the primarily enlarged left atrial diameter over 30 months reflects a further deterioration of the diastolic LV dysfunction.

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“…Of the 42 patients with a systolic murmur, 13(31%) had mitral regurgitation by Doppler, 4 (10%) had tricuspid regurgitation, and 21 (50%) had both; 2 of them also had hemodialysis found a 30 and 36% incidence of asymmet ric septal hypertrophy using M-mode and two-dimen sional echocardiography [12,13]. A similar incidence (30%) was described in hypertensive patients on hemo dialysis [14].…”

Section: Relation Between Auscultatory and Doppler Echocardiographie mentioning

confidence: 80%

Echocardiographic and Doppler Findings in Patients with Chronic Renal Failure on Hemodialysis

Meissner¹,

Panidis²,

McAllister³

et al. 1990

Am J Noninvas Cardiol

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Two-dimensional and Doppler echocardiography were performed in 48 patients (31 men) aged 55 ± 17 years with chronic renal failure (CRF) on hemodialysis for a mean of 3.9 years. Systemic hypertension was present in 44 patients, and a systolic and diastolic murmur in 42 and 6 patients, respectively. Serum creatinine was 10.6 ± 3.1 mg/dl, BUN 69 ± 28 mg/dl and hemoglobin 9 ± 2 g/dl. Left ventricular (LV) hypertrophy was seen in 22 (46%) patients, LV dilatation in 24 (50%) and systolic LV dysfunction in 25 (52%) patients. Pericardial effusion, usually small, was detected in 26 (54%) patients. Peak forward flow velocities (m/s) across each valve by Doppler were: 1.6 ± 0.7 (aortic), 1.0 ± 0.3 (mitral), 0.6 ± 0.2 (tricuspid), and 1.1 ±0.3 (pulmonic). Only 2 patients had significant aortic stenosis (peak velocity ≥ 4.0 m/s). Peak velocities had no correlation with patients’ age, heart rate, duration of hemodialysis, creatinine, or BUN. Aortic regurgitation was detected in 21 (45%) patients, mitral in 38 (79%), tricuspid in 28 (58%) and pulmonary regurgitation 15 (35%) patients. Mitral regurgitation was more common in patients with mitral annular calcification and those with LV dysfunction. Regurgitation was usually mild but multiple valve regurgitation was seen in 31/48 (65 %) patients, involved 3 valves in 13 and all 4 valves in 8 patients. Thus, patients with CRF on hemodialysis have: (1) a high incidence of LV dysfunction, mitral annular calcification and pericardial effusion, (2) increased aortic valve flow velocities but rarely stenosis, and (3) multi valvular regurgitation, more commonly mitral and tricuspid, and usually mild.

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Asymmetric Septal Hypertrophy in Uremic-Normotensive Patients on Regular Hemodialysis

Cited by 20 publications

References 17 publications

Beneficial Effects of Renal Transplantation on Cardiovascular Disorders in Dialysis Patients

Beneficial Effects of Renal Transplantation on Cardiovascular Disorders in Dialysis Patients

Analysis of Left-Ventricular Changes Associated with Chronic Hemodialysis

Echocardiographic and Doppler Findings in Patients with Chronic Renal Failure on Hemodialysis

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