Multi‐modality cardiac imaging in advanced chronic kidney disease

Abstract

Cardiovascular disease (CVD) is the leading cause of death worldwide and is particularly frequent among those with severe renal impairment. Early diagnosis and therapeutic intervention may help alleviate the burden of cardiovascular complication within this population. In the last years, advances have been made toward developing noninvasive imaging techniques that could offer better insight into the cardiac involvement in end‐stage renal disease (ESRD). Conventional transthoracic echocardiography remains the first‐line investigation used to assess cardiac function, but encompassing in our daily practice, the newer approaches such as speckle‐tracking imaging, cardiac computed tomography, or cardiac magnetic resonance can guide us to a more comprehensive understanding of CVD in ESRD. Given that patients with chronic kidney disease may not present with typical CVD symptoms, the amount of information brought by newer imaging techniques is crucial for an accurate diagnosis, risk stratification, and further management. The purpose of this review is to briefly summarize the specific applications of standard cardiac imaging techniques in patients with ESRD and to offer insight into the novel imaging modalities, highlighting the newest research in this field. By doing so, we aim to identify the most important imaging predictors of clinical outcomes in this population.

Randomized Trial of Etelcalcetide for Cardiac Hypertrophy in Hemodialysis

“…47 The use of CMR for the quantification of LVMI reduced the interobserver and intraobserver variability known from using echocardiography and provided accurate anatomic information in excellent agreement with autopsy results. 48,49 A careful evaluation of the patients' volume status throughout the trial and stratification by residual renal function in the randomization mitigated confounding of the treatment effect by volume overload. Blood pressure control was equally good in both groups.…”

Cardiac Magnetic Resonance Imaging Findings in Patients With Chronic Kidney Disease and End-Stage Kidney Disease: A Systematic Review and Meta-Analysis

“…This has been reliably used in the diagnosis of cardiomyopathies, quantification of areas of fibrosis, prognostic determination, and guidance of therapies [38]. Several studies have reported increased T1 values in CKD and ESRD patients [39]. Myocardial fibrosis unrelated to ischemia occurs early in uremic cardiomyopathy, and this increases with the severity of CKD [40].…”

Knowledge landscapes and emerging trends of cardiorenal syndrome type 4: a bibliometrics and visual analysis from 2004 to 2022

“…Therefore, exploring new biomarkers to identify high-risk CKD patients prone to CRS-4 becomes the hotspot, such as asymmetric dimethylarginine (ADMA) [ 33 ], nonoxidized parathyroid hormone (PTH) [ 34 ], sST2 and Gal-3 [ 25 ]. In addition, some noninvasive imaging plays an essential role in assessing heart and vascular abnormalities, for example multi-modality cardiac imaging [ 35 ], and cardiac magnetic resonance [ 36 ]. These techniques can assist in identifying early changes in myocardial tissue characterization [ 37 , 38 ], which can be applied as indicators for early diagnosis and risk stratification of CRS-4.…”