Cardiomyopathy in uraemic patients on long-term haemodialysis.

Brezin, J.; Lyons, Patricia; Bell, James

doi:10.1136/bmj.1.6066.976-a

Cited by 3 publications

(3 citation statements)

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“…Microscopic postmortem analysis of one of our cases with congestive cardiomyopathy has not allowed us to detect any specific lesions characteristic of a partic ular pathology. Reversibility of the myocardial dysfunc tion after renal transplantation has been postulated for one case in the literature [30] but further evidence is lacking.…”

Section: Discussionmentioning

confidence: 99%

Left Ventricular Function in Hemodialyzed Patients with Cardiomegaly

Drüeke¹,

Pailleur²,

M³

et al. 1981

Nephron

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Left ventricular function was investigated in 21 chronic hemodialysis patients with cardiomegaly not due to major pericardial effusion. Angiographic and hemodynamic studies were performed in all, and selective coronary angiography in 16 patients. 5 patients had a history of long-standing arterial hypertension, 5 had clinical evidence of coronary artery disease, 3 had an overfunctioning arteriovenous fistula, and 3 had valvular heart disease. In 10 patients progressive cardiac failure developed without any apparent cause. The diagnosis of congestive cardiomyopathy was established in the latter by left ventricular catheterization. Their myocardial dysfunction was characterized by a significant increase in left ventricular end-diastolic volume when compared to control values. The mean myocardial contractility indices were significantly decreased, as was the index of normalized ventricular rigidity. Of the 10 patients, 6 presented the complete picture of the disease. The remaining 4 also had marked left ventricular dilatation and a decreased normalized rigidity index but their ejection fractions were in the normal range and their myocardial contractility indices only moderately decreased. 7 had coronarography, their coronary arteries were found normal. Of the 5 patients with angina, 3 had significant coronary artery disease as demonstrated by coronary angiography but 2 had angiographic and hemodynamic findings compatible with congestive cardiomyopathy and hypertrophic cardiomyopathy, respectively, in the absence of coronary heart disease. Among the remaining 6 patients with variable underlying etiologies 3 had myocardial dysfunction also compatible with congestive cardiomyopathy while 3 others had left ventricular function near normal. The severe ventricular dysfunction of one of them was possibly related with both aortic and mitral insufficiency. 5 of them had coronary angiography. No significant coronary artery disease could be demonstrated in them. It is concluded that congestive cardiomyopathy in the absence of significant atherosclerotic coronary disease is an important feature of cardiac dysfunction in uremic patients with cardiomegaly undergoing intermittent hemodialysis.

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Section: Discussionmentioning

confidence: 99%

Left Ventricular Function in Hemodialyzed Patients with Cardiomegaly

Drüeke¹,

Pailleur²,

M³

et al. 1981

Nephron

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“…The facts that cardiomyopathy in patients on long-term hemodialysis was not improved by frequent and aggressive hemodialysis, but by renal transplantation, 8) and that accelerated progress of atherosclerosis occurred in patients on chronic hemodialysis1) indirectly suggest unfavorable effects of hemodialysis on the myocardium. The acetate in the dialysis fluid appears to be one of the causative factors for cardiac dysfunction.9) It seems therefore that hemodialysis itself may be responsible for the increasing tendency of LVH and IVSH in group III.…”

Section: Discussionmentioning

confidence: 99%

Echocardiographic and holter findings in 321 uremic patients on maintenance hemodialysis.

et al. 1985

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SUMMARYCardiac manifestations in 321 patients on chronic hemodialysis (dialysis duration of from 0.1 to 11.3 years) were examined with non-invasive technique. In contrast to the previous assumption that cardiac dilatation and pericardial effusion are common in patients on chronic hemodialysis, interventricular septal hypertrophy (51.3%) and left ventricular posterior wall hypertrophy (47.1%) on echocardiography and left ventricular hypertrophy (47.0%) on ECG were the most frequent abnormalities in these patients. Although premature beats on routine ECG were found in a limited number of patients (4.7%), ventricular premature beats were recognized in 45.7% and high grade arrhythmias in 27.2% of 92 patients examined with 24-hour Holter ECG monitoring. There were no high grade arrhythmias and the frequency of ventricular premature beats was 19.4% in 31 age-matched healthy subjects studied. Furthermore, the PQ interval was progressively prolonged in relation to the duration of hemodialysis. This finding may suggest that longterm hemodialysis is associated with disturbances of the conduction system.These results indicate that myocardial hypertrophy and high grade arrhythmias are the prominent findings in uremic patients maintained on hemodialysis. We consider that such high grade arrhythmias could be responsible for a high incidence of cardiac death in these patients.

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“…18]. Some investigators showed extension of the inflammatory pro cess into the adjacent myocardium and postulated, there fore, that pericarditis was a complication of a toxic car diomyopathy [3,8,10], which in itself is a matter of controversy [49], A biochemical basis of'uremic' pericar ditis, e.g. by uremic 'toxins' [24,44] or overhydration [2], has also been postulated, although the lack of correlation between serum creatinine as a marker of biochemical dis order and the incidence of pericarditis was incompatible with this theory.…”

Section: Clinical Datamentioning

confidence: 99%

Humoral Immune Reactions in Uremic Pericarditis

Maisch¹,

Kochsiek²

1983

Am J Nephrol

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Clinical data from 41 patients with pericarditis or pericardial effusion in acute and chronic renal failure were analyzed in respect to the diagnostic relevance of humoral immune reactions. In patients with pericardial effusion in acute renal failure due to surgery or trauma (n = 10), antimyocardial antibodies were rarely detected. In contrast, in the sera of all patients with pericarditis or pericardial effusion following renal failure in chronic or acute glomerulonephritis (n = 6), complement-fixing antisarcolemmal antibodies of the IgM and IgG classes were observed. In patients in whom pericarditis or pericardial effusion evolved during chronic hemodialysis (n = 25), the incidence of complement-fixing antimyolemmal antibodies was 64%. Only sera with complement-fixing antimyolemmal antibodies induced cytolysis of vital adult cardiocytes in vitro suggesting that the antimyolemmal antibodies may not only play a diagnostic but also a pathogenetic role in ‘uremic’ pericarditis in vivo.

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Cardiomyopathy in uraemic patients on long-term haemodialysis.

Cited by 3 publications

References 0 publications

Left Ventricular Function in Hemodialyzed Patients with Cardiomegaly

Left Ventricular Function in Hemodialyzed Patients with Cardiomegaly

Echocardiographic and holter findings in 321 uremic patients on maintenance hemodialysis.

Humoral Immune Reactions in Uremic Pericarditis

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