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Aortic distensibility and arterial-ventricular coupling in early chronic kidney disease: a pattern resembling heart failure with preserved ejection fraction.
Heart 2008; 94(8):1038-43H

Abstract

OBJECTIVES

To examine arterial and left ventricular function and their interaction in patients with early-stage chronic kidney disease (CKD).

DESIGN AND SETTING

Cross-sectional observational study in a university teaching hospital.

PATIENTS

117 patients with stage 2 (60-89 ml/min/1.73 m(2)) or stage 3 (30-59 ml/min/1.73 m(2)) non-diabetic CKD, without overt cardiovascular disease were compared with 40 controls.

INTERVENTIONS

Aortic distensibility and left ventricular mass were assessed using cardiac magnetic resonance imaging. Systolic and diastolic ventricular function and arterial-ventricular elastance (stiffness) were assessed by transthoracic echocardiography.

MAIN OUTCOME MEASURES

Arterial stiffness as measured by aortic distensibility and arterial elastance. Left ventricular mass, left ventricular systolic and diastolic function, including end-diastolic and end-systolic elastance and their relationship with arterial elastance.

RESULTS

Compared with controls, patients with CKD 2 and CKD 3 had reduced aortic distensibility (4.12 (1.3) vs 2.94 (1.8) vs 2.18 (1.8)x10(-3) mm Hg, p<0.01), increased arterial elastance (1.4 (1.3) vs 1.65 (0.40) vs 1.74 0.48) mm Hg, p<0.05) and increased end-systolic (1.88 (0.48) vs 2.43 (0.83) vs 2.42(0.78) mm Hg/ml, p<0.05) and end diastolic elastances (0.07 (0.04) vs 0.11 (0.04) vs 0.12 (0.04, p<0.01). Aortic distensibility was positively correlated with estimated glomerular filtration rate (r = 0.349, p<0.01) and indices of elastance were inversely correlated (r = 0.284, p<0.05). Systolic function was not impaired in patients with early CKD compared with controls but diastolic filling velocities (Em) were reduced (8.1 (0.9) vs 7.9 (0.6) vs 7.5 (0.7) cm/s, p<0.01) while mean left atrial pressure (E/Em) was increased (5.6 (1.1), vs 7.4 (1.8) vs 8.0 (2.4), p<0.01) and end-diastolic elastance was increased.

CONCLUSIONS

Early-stage CKD is characterised by reduced aortic distensibility and increases in arterial, ventricular systolic and diastolic stiffness; arterial-ventricular coupling is preserved. This pattern of pathophysiological abnormalities resembles that seen in heart failure with preserved ejection fraction and may account for the high levels of cardiovascular morbidity and mortality in patients at all stages of CKD.

TRIAL REGISTRATION NUMBER

NCT00291720.

Authors+Show Affiliations

Department of Cardiology, University of Birmingham and University Hospital Birmingham, Birmingham, UK.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18308865

Citation

Edwards, N C., et al. "Aortic Distensibility and Arterial-ventricular Coupling in Early Chronic Kidney Disease: a Pattern Resembling Heart Failure With Preserved Ejection Fraction." Heart (British Cardiac Society), vol. 94, no. 8, 2008, pp. 1038-43.
Edwards NC, Ferro CJ, Townend JN, et al. Aortic distensibility and arterial-ventricular coupling in early chronic kidney disease: a pattern resembling heart failure with preserved ejection fraction. Heart. 2008;94(8):1038-43.
Edwards, N. C., Ferro, C. J., Townend, J. N., & Steeds, R. P. (2008). Aortic distensibility and arterial-ventricular coupling in early chronic kidney disease: a pattern resembling heart failure with preserved ejection fraction. Heart (British Cardiac Society), 94(8), pp. 1038-43. doi:10.1136/hrt.2007.137539.
Edwards NC, et al. Aortic Distensibility and Arterial-ventricular Coupling in Early Chronic Kidney Disease: a Pattern Resembling Heart Failure With Preserved Ejection Fraction. Heart. 2008;94(8):1038-43. PubMed PMID: 18308865.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Aortic distensibility and arterial-ventricular coupling in early chronic kidney disease: a pattern resembling heart failure with preserved ejection fraction. AU - Edwards,N C, AU - Ferro,C J, AU - Townend,J N, AU - Steeds,R P, Y1 - 2008/02/28/ PY - 2008/3/1/pubmed PY - 2008/8/8/medline PY - 2008/3/1/entrez SP - 1038 EP - 43 JF - Heart (British Cardiac Society) JO - Heart VL - 94 IS - 8 N2 - OBJECTIVES: To examine arterial and left ventricular function and their interaction in patients with early-stage chronic kidney disease (CKD). DESIGN AND SETTING: Cross-sectional observational study in a university teaching hospital. PATIENTS: 117 patients with stage 2 (60-89 ml/min/1.73 m(2)) or stage 3 (30-59 ml/min/1.73 m(2)) non-diabetic CKD, without overt cardiovascular disease were compared with 40 controls. INTERVENTIONS: Aortic distensibility and left ventricular mass were assessed using cardiac magnetic resonance imaging. Systolic and diastolic ventricular function and arterial-ventricular elastance (stiffness) were assessed by transthoracic echocardiography. MAIN OUTCOME MEASURES: Arterial stiffness as measured by aortic distensibility and arterial elastance. Left ventricular mass, left ventricular systolic and diastolic function, including end-diastolic and end-systolic elastance and their relationship with arterial elastance. RESULTS: Compared with controls, patients with CKD 2 and CKD 3 had reduced aortic distensibility (4.12 (1.3) vs 2.94 (1.8) vs 2.18 (1.8)x10(-3) mm Hg, p<0.01), increased arterial elastance (1.4 (1.3) vs 1.65 (0.40) vs 1.74 0.48) mm Hg, p<0.05) and increased end-systolic (1.88 (0.48) vs 2.43 (0.83) vs 2.42(0.78) mm Hg/ml, p<0.05) and end diastolic elastances (0.07 (0.04) vs 0.11 (0.04) vs 0.12 (0.04, p<0.01). Aortic distensibility was positively correlated with estimated glomerular filtration rate (r = 0.349, p<0.01) and indices of elastance were inversely correlated (r = 0.284, p<0.05). Systolic function was not impaired in patients with early CKD compared with controls but diastolic filling velocities (Em) were reduced (8.1 (0.9) vs 7.9 (0.6) vs 7.5 (0.7) cm/s, p<0.01) while mean left atrial pressure (E/Em) was increased (5.6 (1.1), vs 7.4 (1.8) vs 8.0 (2.4), p<0.01) and end-diastolic elastance was increased. CONCLUSIONS: Early-stage CKD is characterised by reduced aortic distensibility and increases in arterial, ventricular systolic and diastolic stiffness; arterial-ventricular coupling is preserved. This pattern of pathophysiological abnormalities resembles that seen in heart failure with preserved ejection fraction and may account for the high levels of cardiovascular morbidity and mortality in patients at all stages of CKD. TRIAL REGISTRATION NUMBER: NCT00291720. SN - 1468-201X UR - https://www.unboundmedicine.com/medline/citation/18308865/Aortic_distensibility_and_arterial_ventricular_coupling_in_early_chronic_kidney_disease:_a_pattern_resembling_heart_failure_with_preserved_ejection_fraction_ L2 - http://heart.bmj.com/cgi/pmidlookup?view=long&amp;pmid=18308865 DB - PRIME DP - Unbound Medicine ER -