Longitudinal changes of left and right cardiac structure and function in patients with end-stage renal disease on replacement therapy

Luca Arcari; Giuseppino Massimo Ciavarella; Silvia Altieri; Luca Rosario Limite; Domitilla Russo; Michelangelo Luciani; Luciano De Biase; Paolo Mené; Massimo Volpe

doi:10.1016/j.ejim.2020.04.051

Longitudinal changes of left and right cardiac structure and function in patients with end-stage renal disease on replacement therapy

Eur J Intern Med. 2020 Aug:78:95-100. doi: 10.1016/j.ejim.2020.04.051. Epub 2020 May 10.

Authors

Luca Arcari¹, Giuseppino Massimo Ciavarella², Silvia Altieri³, Luca Rosario Limite², Domitilla Russo², Michelangelo Luciani⁴, Luciano De Biase⁵, Paolo Mené³, Massimo Volpe⁶

Affiliations

¹ Cardiology Unit, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy; Department of Cardiology, Madre Giuseppina Vannini Hospital, Rome, Italy. Electronic address: luca_arcari@outlook.it.
² Cardiology Unit, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.
³ Division of Nephrology, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.
⁴ Internal Medicine Unit, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.
⁵ Heart Failure Unit, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.
⁶ Cardiology Unit, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli, IS, Italy.

PMID: 32402562
DOI: 10.1016/j.ejim.2020.04.051

Abstract

Background: Few data are available regarding longitudinal changes of cardiac structure and function in end-stage chronic kidney disease (CKD). Aim of the present study is to describe serial echocardiographic findings in a cohort of dialyzed CKD patients.

Methods: In this retrospective longitudinal study, we included n = 120 dialyzed CKD patients who underwent at least 2 echocardiograms either 1, 2 or 3 years apart. After baseline echocardiogram, n = 112 had a further examination at year 1, n = 76 at year 2 and n = 45 at year 3. Echocardiographic examination included Tissue Doppler Imaging of both left (LV) and right (RV) ventricle.

Results: LV geometry and LV mass index did not significantly change over time. RV progressively dilated (mean change +1.3 mm, +1.1 mm and +3.1 mm at year 1, 2 and 3 respectively, p = 0.002, adjusted p = 0.003). Tissue Doppler parameters showed significant changes with regard to both LV (mean change of E/E' +0.7, +1.3, +1.7 at year 1, 2 and 3 respectively p<0.001, adjusted p = 0.079) and RV (mean change of S wave (cm/sec) -1, -1.7, -2 at year 1, 2 and 3 respectively, p <0.001, adjusted p = 0.041). Decrease of RV S wave negatively correlated with E/E' changes (r=-0.303, p = 0.002; r=-0.246, p = 0.049; r=-0.265, p = 0.089; at year 1, 2 and 3 respectively). LV ejection fraction (LVEF) progressively declined (p = 0.034, adjusted p = 0.140), albeit being significant lower against baseline only at year 3 (mean change -4.3%, p<0.05).

Conclusions: In dialyzed CKD patients we observed parallel worsening of LV diastolic and RV systolic function accompanied by RV dilation. LVEF decreased less sharply.

Keywords: Chronic kidney disease; Dialysis; Diastolic dysfunction; Right ventricle; Tissue Doppler echocardiography.

MeSH terms

Echocardiography
Heart Ventricles* / diagnostic imaging
Humans
Kidney Failure, Chronic* / therapy
Longitudinal Studies
Retrospective Studies