Diastolic function in chronic kidney disease

Abstract

Chronic kidney disease (CKD) is characterized by clustered age-independent concentric LV geometry, geometry-independent systolic dysfunction, and age and heart rate-independent diastolic dysfunction. Concentric LV geometry is always associated with echocardiographic markers of abnormal LV relaxation and increased myocardial stiffness, two hallmarks of diastolic dysfunction. Non hemodynamic mechanisms such as metabolic and electrolyte abnormalities, activation of biological pathways, and chronic exposure to cytokine cascade and myocardial macrophage system also impact myocardial structure and impair the architecture of myocardial scaffold, producing and increasing reactive fibrosis, and altering myocardial distensibility. This review addresses pathophysiology of diastole in CKD, and relations with cardiac mechanics, hemodynamic loading, structural conditions, non-hemodynamic factors, and metabolic characteristics. The three mechanisms of diastole will be examined: elastic recoil, active relaxation, and passive distensibility and filling. Based on current evidence, we briefly give indications on methods for quantification of diastolic function and discuss on whether diastolic dysfunction represents a distinct characteristic in CKD or rather a proxy of the severity of cardiovascular condition, with the potential to be predicted by the general cardiovascular phenotype. Finally, the review discusses the opportunity of assessment of diastolic function in the context of CKD, with special emphasis on end-stage kidney disease, to indicate whether and when in-depth measurements might be helpful for clinical decision making in this context.

Association of 1,25 dihydroxyvitamin D with left ventricular hypertrophy and left ventricular diastolic dysfunction in patients with chronic kidney disease

“…The reason for this remains unclear, but factors related to CKD, aside from LVH, may influence the occurrence of LVDD. Previous studies have proposed that LVDD could be influenced by an increase in LV preload due to progression of renal dysfunction in CKD [ 21 , 22 ]. Additionally, neurohumoral alterations, inflammation, anemia, and mineral disorders are thought to contribute to the development of LVDD [ 21 , 22 ].…”

Assessment of left atrial function provides incremental value: the left atrial volumetric/mechanical coupling index in patients with chronic kidney disease

“…Diastolic late mitral annular velocity (a’) measured by transthoracic echocardiography is reported to represent LA pump function and the severity of LA remodelling ( 38 ). It is highly correlated with complex measures of LA performance and can be measured in routine practice ( 39 ). Thus, when assessing LA function, it is crucial to combine a measurement of atrial stretch (LAVI) with a measurement of LA mechanical activity (TDI-a’, which is less affected by LV diastolic function than A wave).…”