Characterization of myocardial tissue in patients undergoing maintenance hemodialysis by quantitative echocardiography

Morales, Maria‐Aurora; Ferdeghini, E.M.; Pizzarelli, Francesco; Piacenti, Marcello; Dattolo, Pietro; Pelosi, Gualtiero; Distante, Alessandro; Maggiore, Q

doi:10.1016/s0894-7317(96)90119-4

Cited by 10 publications

(9 citation statements)

References 34 publications

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“…Demgegenüber stehen die die Echokardiographie kennzeichnenden Vorteile einer nahezu ubiquitären Verfügbarkeit, der geringen Patientenbelastung sowie der noch immer kernspintomographisch nur bedingt zu erzielenden zeitlichen Auflösung. Damit bleibt die Echokardiographie weiterhin die erste Stufe im Rahmen der diagnostischen Abklärung bei Verdacht auf eine kardiale Mitbeteiligung [21].…”

Section: Statistikunclassified

“…Als Limitation des Studiendesigns muss die fehlende Flussmessung genannt werden, die eine quantitative Bestimmung ermöglicht hätte. Diese von uns erhobenen Befunde decken sich mit echokardiographischen Beobachtungen; die ¾tiologie dieser häufig erst unter HD auftretenden Verkalkungen der Klappen wird bisher kontrovers diskutiert [21,22].…”

Section: Statistikunclassified

“…einer chronischen Hypervolämie auf Grundlage von arteriovenösen Shuntsystemen sowie einer erhöhten Natrium-bzw. Wasserretention gesehen werden[21,26,27].Eine chronisch bestehende Urämie kann demnach zu zahlreichen strukturellen und funktionellen Veränderungen des Herzens führen. Neben einer LV-Dilatation (Volumenbelastung) zeigten alle Patienten eine manifeste Myokardhypertrophie (Druckbelastung) sowie in Einzelfällen diastolische Relaxationsstörungen (Myokardfibrose).…”

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TrueFISP-MR-Bildgebung zur Bestimmung des Einflusses der Hämodialyse auf myokardiale Funktionsparameter bei Patienten mit terminaler Niereninsuffizienz

Krämer

Wolf²,

Fenchel³

et al. 2004

Fortschr Röntgenstr

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Section: Statistikunclassified

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TrueFISP-MR-Bildgebung zur Bestimmung des Einflusses der Hämodialyse auf myokardiale Funktionsparameter bei Patienten mit terminaler Niereninsuffizienz

Krämer

Wolf²,

Fenchel³

et al. 2004

Fortschr Röntgenstr

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“…Die E r k e n n u n g und Z u o r d n u n g von Zusatzstrukturen erfolgen anhand anatomisch-morphologischer Kriterien wie Gr6/3e, Lokalisation und Verbindung zum gesunden Gewebe. Zur Optimierung der Erkennung struktureller Gewebever~inderungen wurden zun~ichst A n a l y s e v e r f a h r e n zur Bestimmung der Grauwertdichte entwickelt [10], mit deren Hi|fe sich beispielsweise Kalzifizierungen im G e w e b e quantitativ beschreiben lassen [12]. Diese Verfahren, von denen die Videodensitometrie am bekanntesten ist, k o m m e n jedoch vorwiegend zur Erfassung geweblicher Ver~inderungen an regultiren Strukturen zum Einsatz [6,7].…”

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Verbesserte Strukturidentifizierung mittels Gewebe-Doppler-Echokardiographie

Bartel

Müller²,

Möhlenkamp

et al. 1998

Herz

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Tissue Doppler echocardiography (TDE) has been shown to be of particular value in patients with impaired myocardial function. Recently, the technique was successfully employed to localize the ventricular insertion of accessory atrioventricular pathways. The identification of abnormal cardiac structures is coming up now as a new field of clinical interest. The purpose of this study was to differentiate anomalous cardiac and aortic from native structures by physical properties of tissue motion using transesophageal TDE. Characteristic motion patterns of anomalous structures have not been described in detail and tissue Doppler findings have not been associated with clinical features up to now. Forty consecutive patients were included after anomalous cardiac or vascular structures had been detected by conventional transesophageal echocardiography (TEE). A control group consisted of 20 subjects. Rapidity of diagnosis in anomalous structures was divided into 3 categories, and TDE signals were related to particular pathology by a blinded, 2nd observer. Three different motion patterns could be defined: incoherent motion due to free oscillation of an anomalous structure which is independent of the surrounding tissue (Figure 1b); coherent motion with a phase difference meaning that motion depends on the motion of the surrounding tissue but is out of phase (Figure 2); concordant motion showing no difference in direction, velocity, or phase of motion compared with the surrounding tissue. Incoherent motion was present in endocarditic vegetations, 4th degree aortic plaques, Chiari network, valvular prolapse, intracavitary tumors, and freely oscillating thrombi as well as in normal valve leaflets and papillary muscles. Especially if endocarditic vegetations are present its incoherent motion facilitates to recognize these small structures. The colorcode of this motion pattern demarcates the vegetation reliably from the surrounding tissue (Figure 1b). Within 15 seconds vegetations could be detected in 9 (82%) vs 2 (18%) patients employing only conventional imaging. Using conventional echocardiographic approaches detection of vegetations is frequently hindered by their small size and minor echo intensity (Figure 1a). In contrast, size and echo intensity do not affect the tissue Doppler signal. Normal papillary muscles and distal portions of the mitral and tricuspid valves were demonstrated to regularly meet the criterion of incoherent tissue motion in the control group. In part, this was also observed with respect to the aortic and pulmonary valves. In valvular tissue incoherent motion was caused by passive floating, whereas papillary muscles show an active inverse motion for short time intervals. Nevertheless, physiologic incoherent motion did not lead to any false differential diagnosis. The phase difference of coherent motion results from damped oscillation. This phenomenon was visualized by tissue Doppler M-mode in 5 thrombi of the left atrial appendage (LAA) (100%) and in 1 ventricular thrombus (50% of all clots). Concordant ...

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“…It has been suggested that echocardiographic tissue analysis may be clinically useful in various types of cardiac pathology [13][14][15][16][17], including uremic cardiopathy [18][19][20][21][22][23][24][25][26].…”

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Parameters derived by ultrasonic myocardial characterization in dialysis patients are associated with mortality

Pizzarelli

Dattolo²,

Ferdeghini³

et al. 2005

Kidney International

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Parameters derived by ultrasonic myocardial characterization in dialysis patients are associated with mortality.Background. Autopsy studies have shown that hypertrophic hearts of uremic patients have peculiar characteristics. Changes in tissue structure are detectable by ultrasound as changes in echo reflectivity.Methods. We studied 96 dialysis patients, 18 hypertensive subjects with normal renal function and 52 healthy subjects. The echo pattern of interventricular septum was assessed by videodensitometry (VDT) (i.e., a computer-assisted quantitative analysis of gray levels). For each pixel a numerical value from 0 (black) to 255 (white) was assigned. From the resulting histogram of gray level frequency distribution, we obtained indexes of central tendency (reflectivity) and of homogeneity of distribution (uniformity).Results. For the same septum thickness, dialysis patients showed a significantly greater reflectivity (87 ± 19 and 70 ± 17) (P < 0.001) and lower uniformity (137 ± 32 and 184 ± 71) (P < 0.007) compared with hypertensives. Hypertensive patients showed VDT parameters similar to control subjects in spite of significantly higher septum thickness (P < 0.003). Followed up after 5 years, dialysis patients with a reduced homogeneity of distribution of gray levels (lower uniformity) showed a significantly shorter survival (HR by Cox 2.5, 95% CI 1.21-5.27).Conclusion. For a similar degree of cardiac hypertrophy, dialysis patients differed widely from hypertensives in their VDT parameters. By contrast, the hypertensive heart differed from the normal heart in the degree of hypertrophy but not in terms of VDT parameters. VDT parameters are independent predictors of all-cause mortality in dialysis patients.Left ventricular hypertrophy (LVH), the most frequent cardiac alteration on patients in chronic hemodialysis [1][2][3], is an independent risk factor for survival [1,4,5].Few studies suggest that not only the cardiac mass per se, but also the type of geometric patterns of remodeling, has an impact on survival [6,7].

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Characterization of myocardial tissue in patients undergoing maintenance hemodialysis by quantitative echocardiography

Cited by 10 publications

References 34 publications

TrueFISP-MR-Bildgebung zur Bestimmung des Einflusses der Hämodialyse auf myokardiale Funktionsparameter bei Patienten mit terminaler Niereninsuffizienz

TrueFISP-MR-Bildgebung zur Bestimmung des Einflusses der Hämodialyse auf myokardiale Funktionsparameter bei Patienten mit terminaler Niereninsuffizienz

Verbesserte Strukturidentifizierung mittels Gewebe-Doppler-Echokardiographie

Parameters derived by ultrasonic myocardial characterization in dialysis patients are associated with mortality

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