Left Ventricular Function in Hemodialyzed Patients with Cardiomegaly

Abstract

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.

Beneficial Effects of Renal Transplantation on Cardiovascular Disorders in Dialysis Patients

“…Uremic cardiomyopathy was manifested as systolic dysfunction, concentric LV hypertrophy, or LV dilatation by echocardiogrophic evaluation, the most significant predictor of the development of cardiac failure and mortality being systolic dysfunction. 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.…”

CAPD Is More Advantageous than Hemodialysis

“…It is generally agreed that hemodialysis produces an improvement in left ventricular (LV) systolic function (10): an increase in LV contractility and a decrease in left ventricular end-diastolic volume and stroke volume. However, the improvement in LV systolic function depends on predialysis LV volume and systolic function; hemodialysis induces an increase in LV ejection fraction in patients with a reduced ejection fraction prior to dialysis but not in those with a normal predialysis ejection fraction (1 1).…”

In vitro Approach to ‘Uremic Cardiomyopathy’

“…Congestive heart failure is a common complication in chronic hemodialysis patients [1,2], The cardiac perfor mance in uremia is clinically characterized by an inade quate left ventricular hypertrophy and a reduced diastolic compliance [3], Echocardiographic examinations demon strated a dilatation of the left ventricular internal diameter and a diminished fractional fiber shortening [4], Addition ally, an increase in left ventricular end-diastolic and endsystolic volumes as well as a reduction of myocardial con tractility and a decrease in left ventricular ejection fraction was described in patients with end-stage renal disease [5], Moreover, the hemodynamic state of chronic hemodialysis patients is characterized by an elevated cardiac output, an increased systemic vascular resistance, an elevated mean arterial pressure and an increased intravascular volume [6,7], Many factors chronically disturbed in renal failure may contribute to the complex cardiac findings: anemia [8], chronic fluid and volume overload, arterial hypertension, arteriovenous shunting of blood, episodic extracorporeal circulation, and increased cardiac work load. Alterations in the inotropic state of the heart induced by arrhythmias [9], myocardial damage based on coronary artery disease [10] or induced by metabolic and electrolyte imbalances are pos sibly involved in the pathogenesis of cardiac dysfunction in end-stage renal failure [1,11].…”