Studies on the Mechanisms Underlying the Myocardial Texture Changes in Uremics

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

doi:10.1159/000425473

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“…It is tempting to speculate that these abnormalities, namely intermyocytic fibrosis and/or calcium [24,25]. However, the present study was not designed to investigate the mechanisms underlying altered cardioreflectance, and that question thus remains open for later studies.…”

Section: Discussionmentioning

confidence: 95%

“…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].…”

mentioning

confidence: 99%

“…Extending our previous experience [24][25][26], in this study we hoped to determine whether echocardiographic tissue analysis is capable of (1) capturing in vivo differences in the echo signal of the hypertrophic myocardium of uremic subjects in comparison with the hypertrophic myocardium of subjects with arterial hypertension and normal renal function; and (2) whether the ultrasonic alterations of the hypertrophic uremic myocardium are independent risk factors for survival.…”

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confidence: 99%

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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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Section: Discussionmentioning

confidence: 95%