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| DETERMINANTS OF LEFT-VENTRICULAR HYPERTROPHY AND SYSTOLIC DYSFUNCTION IN CHRONIC-RENAL-FAILURE |
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| Author(s): GREAVES SC, GAMBLE GD, COLLINS JF, WHALLEY GA, SHARPE DN |
| Source: AMERICAN JOURNAL OF KIDNEY DISEASES Volume: 24 Issue: 5 Pages: 768-776 Published: NOV 1994 |
| Times Cited: 90 References: 34 |
| Abstract: To evaluate determinants of left ventricular hypertrophy (LVH) and left ventricular (LV) systolic dysfunction in chronic renal failure (CRF), M-mode and two-dimensional echocardiography were performed in 38 undialyzed patients with CRF (serum creatinine greater than or equal to 3.4 mg/dL), 54 patients receiving continuous ambulatory peritoneal dialysis, 30 patients receiving hemodialysis, and 59 healthy age- and sex-matched volunteers. Left ventricular (LV) wall thickness and LV dimensions were greatest in dialysis patients, intermediate in CRF patients, and least in control subjects. LV mass index calculated from M-mode measurements was 78.7 g/m(2) +/- 14.8 g/m(2) in controls, 120.5 g/ m(2) +/- 28.7 g/m(2) in CRF patients, and 138 +/- 45.0 g/m(2) in dialysis patients (P < 0.0001). LV fractional shortening and LV velocity of circumferential shortening were lower in dialysis patients than in CRF patients and controls (fractional shortening 36.5% +/- 5.6% in controls, 36.2% +/- 7.2% in CRF patients, and 29.8% +/- 8.9% in dialysis patients; P < 0.0001). Echocardiography was normal in only 24 dialysis patients (29%) and 14 CRF patients (37%) (P = NS). Thirty-nine dialysis patients (46%) and 10 CRF patients (26%) had LVH (P = NS). Thirty dialysis patients (36%) and five CRF patients (13%) had LV systolic dysfunction (P < 0.05). LV hypertrophy with LV systolic dysfunction was present in 15 dialysis patients but no CRF patients (P < 0.05). There were no significant differences between hemodialysis patients and continuous ambulatory peritoneal dialysis patients in M-mode echocardiographic measurements or the frequency of LVH and LV systolic dysfunction. Using multiple regression analysis, LV wall thickness was positively correlated with systolic blood pressure (P < 0.001, r(2) = 10.3%), where r(2) is the variance explained independent of other variables. LV mass index was positively correlated with diastolic blood pressure (P < 0.05, r(2) = 6.7%) and inversely correlated with hematocrit (P < 0.01, r(2) = 8.1%). Logistic regression analysis showed that LVH was positively correlated with systolic blood pressure (P < 0.005) and diabetic nephropathy (P < 0.005). LV systolic dysfunction was positively correlated with age (P < 0.01). No relationship between secondary hyperparathyroidism and cardiac disease was found. Conclusions: LV hypertrophy and LV systolic dysfunction occur frequently in both peritoneal dialysis patients and hemodialysis patients. LV hypertrophy is also common in undialyzed patients with moderate to severe CRF, but systolic function is usually preserved in these patients. The strongest independent predictors of LVH in this study were hypertension, diabetes, and anemia. Age was the strongest independent predictor of LV systolic dysfunction. Additional laboratory and prospective clinical studies are needed to further elucidate the mechanisms involved in the development of LVH and LV impairment in renal failure, and undialyzed patients with moderate or severe CRF should be included in such studies, as cardiac disease is frequently established prior to dialysis. (C) 1994 by the National Kidney Foundation, Inc. |
| Document Type: Article |
| Language: English |
Addresses:
1. UNIV AUCKLAND, AUCKLAND HOSP, SCH MED, DEPT MED, AUCKLAND, NEW ZEALAND |
| Publisher: W B SAUNDERS CO, INDEPENDENCE SQUARE WEST CURTIS CENTER, STE 300, PHILADELPHIA, PA 19106-3399 |
| Subject Category: Urology & Nephrology |
| IDS Number: PR329 |
| ISSN: 0272-6386 |
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