Uremic cardiomyopathy: An inadequate left ventricular hypertrophy

London, Gérard M.; Fabiani, F; Marchais, Sylvain J.; Vernejoul, Marie‐Christine de; Guérin, Alain P.; Safar, Michel E.; Mëtivier, Fabien; Llach, Francisco

doi:10.1038/ki.1987.94

Cited by 231 publications

(116 citation statements)

References 27 publications

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“…21 Several additional mechanisms may come into play in the genesis of LVH, including hyperparathyroidism. 22 The LVM index, which is an appropriate measurement of LVH even in patients undergoing chronic HD, 23 increases not only from corresponding hemodynamic overload but also from remodeling to compensate for decreased myocardial contractility. That is, when myocardial contractility becomes insufficient for general circulatory requirements, myocardial stretch increases this function according to Frank -Starling's law.…”

Section: Discussionmentioning

confidence: 99%

L-Carnitine Supplementation Decreases the Left Ventricular Mass in Patients Undergoing Hemodialysis

Sakurabayashi

Miyazaki

Yuasa

et al. 2008

Circ J

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Background Patients on long-term hemodialysis become deficient in carnitine and are frequently treated with carnitine supplementation to offset their renal anemia, lipid abnormality and cardiac dysfunction. The therapeutic value of carnitine supplementation on left ventricular hypertrophy (LVH) in patients with normal cardiac systolic function remains uncertain. Methods and ResultsThe cardiac morphology and function of 10 patients given 10 mg/kg of L-carnitine orally, immediately after hemodialysis sessions 3 times per week for a 12-month period were compared with 10 untreated control patients. Using echocardiography, left ventricular fractional shortening (LVFS) and left ventricular mass index (LVMI) were measured before and after the study period. As a result, amounts of serum-free carnitine increased from 28.4±4.7 to 58.5±12.1 mol/L. The LVMI decreased significantly from 151.8±21.2 to 134.0±16.0 g/m 2 in treated patients (p<0.01), yet the LVMI in untreated control patients did not change significantly (ie, from 153.3±28.2 to 167.1±43.1 g/m 2 ). However, LVFS values remained unchanged in both groups. Although L-carnitine promoted a 31% reduction in erythropoietin requirements, hematocrit and blood pressure did not change during the study period. Conclusions Supplementation with L-carnitine induced regression of LVH in patients on hemodialysis, even for those with normal systolic function. (Circ J 2008; 72: 926 -931)

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Section: Discussionmentioning

confidence: 99%

L-Carnitine Supplementation Decreases the Left Ventricular Mass in Patients Undergoing Hemodialysis

Sakurabayashi

Miyazaki

Yuasa

et al. 2008

Circ J

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“…17,18 In chronic anaemia there is a reduction in after-load due to arterial dilatation caused by decreased vascular resistance, similar to that produced by antihypertensive drugs. This vasodilatation facilitates pressure transmission from the arterial system to the venous circulation, increasing pre-load and cardiac filling.…”

Section: Ai Gunal I Karaca B Aygen Et Al Strict Fluid Volume Contrmentioning

confidence: 99%

Strict Fluid Volume Control and Left Ventricular Hypertrophy in Hypertensive Patients on Chronic Haemodialysis: A Cross-Sectional Study

Karaca

Aygen

et al. 2004

J Int Med Res

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Left ventricular hypertrophy (LVH) is very common in haemodialysis patients.We measured left ventricular mass in three groups of haemodialysis patients: group A (n = 40) were normotensive and receiving a strict salt-restricted diet; group B (n = 23) were normotensive and receiving antihypertensive drugs; and group C (n = 43) were hypertensive despite anti-hypertensive drug treatment. The interdialytic weight gain in group B and group C was significantly higher than in group A; the mean left atrial index and left ventricular end-systolic and end-diastolic diameter indices were all higher in group B than in group A. The interventricular septum and posterior wall were significantly thicker in group B and group C than group A, resulting in a higher left ventricular mass index. Left ventricular systolic and diastolic function parameters were slightly better in group A than in the other groups. These results show that strict fluid volume control decreases blood pressure, reduces dilated cardiac compartments and corrects LVH more effectively than lowering blood pressure without correcting the volume overload.

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“…[4] It is considered a predictor of both cardiovascular events and deaths in patients with ESRD, regardless of age, diabetes mellitus, hypertension, hyperlipidemia, smoking, and coronary heart disease. [5][6][7][8][9] However, apart from myocardial mass gain, abnormal left ventricular (LV) geometry is also associated with poor outcome in chronic dialysis patients, [10] and different geometric models (concentric or eccentric hypertrophy as well as concentric remodeling) play an important role as well. [11][12][13][14][15] Risk of cardiovascular events is the highest in patients with concentric LVH (cLVH).…”

Section: Introductionmentioning

confidence: 99%

Prevalence and Risk Factors of Myocardial Remodeling in Hemodialysis Patients

et al. 2009

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Background. Left ventricular hypertrophy (LVH) is an independent risk factor for morbidity/mortality in patients with end stage renal disease (ESRD). Our study aimed to identify prevalence as well as independent risk factors that contribute to the development of LV geometric remodeling in our HD patients. Methods. The left ventricles of 116 HD patients were classified echocardiographically into four different geometric patterns on the basis of LV mass and relative wall thickness. Furthermore, we measured inferior vena cava (IVC) diameter and its collapsibility index (CI) by echocardiography. Finally, we modeled a stepwise multiple regression analysis to determine the predictors of LV geometry. Results. Our study provides evidence that HD patients had a prevalence of abnormal LV geometry in 92% and LVH in 81%. We found all four geometric models of LV. Most dominant were eccentric LVH. Concentric LVH was observed in 37, normal geometry (NG) in 9, and concentric remodeling (CR) in 13 of HD patients. Mean arterial blood pressure was significantly higher in the cLVH group (95 ± 10 mmHg) than in the NG and CR groups (81.6 ± 12.3 and 80 ± 11.8, respectively, p < 0.001). The cLVH and eCLVH groups had significantly lower mean hemoglobin (10.3 ± 1.4g/dL and 10.6 ± 1g/dL, respectively) compared with the NG group (11.9 ± 1.4g/dL), p < 0.001. Furthermore, interdialytic weight gain (kg) was significantly higher in eCLVH group (3.13 ± 0.8) than in NG group (2.3 ± 1.1), p < 0.001. Mean IVC index of the eLVH group (10.83 ± 2.07 mm/m 2 ) was significantly higher than corresponding indexes of NG (10.83 ± 2.07 mm/m 2 ), CR (8.31 ± 1.32 mm/m 2 ) and cLVH (8.12 ± 2.06 mm/m 2 ) groups (p < 0.001 for each comparisons). Conclusion. Mean arterial pressure, hemoglobin, IVC index, and interdialytic weight gain were found to be independent predictors of LV geometry (R 2 = 0.147; p < 0.001) in HD patients.

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Uremic cardiomyopathy: An inadequate left ventricular hypertrophy

Cited by 231 publications

References 27 publications

L-Carnitine Supplementation Decreases the Left Ventricular Mass in Patients Undergoing Hemodialysis

L-Carnitine Supplementation Decreases the Left Ventricular Mass in Patients Undergoing Hemodialysis

Strict Fluid Volume Control and Left Ventricular Hypertrophy in Hypertensive Patients on Chronic Haemodialysis: A Cross-Sectional Study

Prevalence and Risk Factors of Myocardial Remodeling in Hemodialysis Patients

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