Key result
Haemodialysis is linked to a markedly lower myocardial cyclic variation index versus hypertensives and controls.
Why the study?
Videodensitometric parameters of the myocardium in dialysis patients, a complex model of pressure volume overload, and in hypertensive patients with similar left ventricular mass were not well characterized.
Do videodensitometric parameters of the myocardium differ in dialysis patients compared to hypertensive patients with similar left ventricular mass and healthy controls?
Observational (n=45)
Do videodensitometric parameters of the myocardium differ in dialysis patients compared to hypertensive patients with similar left ventricular mass and healthy controls?
Absolute Event Rate: -2.5% vs 11.8%
p-value: p=<0.001
Dialysis patients exhibit significantly greater abnormalities in echocardiographic grey level distribution (lower CVI) than hypertensive patients with similar left ventricular hypertrophy, potentially representing an early stage of uraemic cardiomyopathy related to iPTH levels.
Reduced cyclic variation index may indicate myocardial changes in haemodialysis; Level 4 evidence leaves open prognostic value.
BACKGROUND: The aim of this study was to investigate videodensitometric parameters of the myocardium, in dialysis patients, who represent a complex pathophysiological model of pressure volume overload, and in essential hypertensive patients with the same level of left ventricular mass. METHODS: We compared a group of male dialysis patients (D) with two groups: hypertensive patients (H) with comparable left ventricular mass and normotensive healthy subjects as controls (C). The groups (n=15 each) were age- (53 +/- 9 years) and gender-matched. Quantitative analysis of echocardiographic digitalized imaging was performed to calculate the mean grey level (MGL) and cyclic variation index (CVI). RESULTS: The haemodialysis patients had a significantly lower CVI compared with hypertensives and controls both for septum (D): -2.5 +/- 17.4% vs (H); 11.8 +/- 17% vs (C); 43.2 +/- 15.4% (P<0.001) and for posterior wall (D): -10.1 +/- 261% vs (H); 14.2 +/- 14.7% vs (C); 46.6 +/- 17.2% (P<0.001). A significant inverse relationship was found between intact parathyroid hormone (iPTH) and CVI. CONCLUSION: Abnormalities of two-dimensional echocardiographic grey level distribution are present in both haemodialysis patients and hypertensive patients, but seem unrelated to the degree of echocardiographic hypertrophy. These videodensitometric myocardial alterations are significantly higher in dialysis patients than in hypertensive patients with the same extent of left ventricular hypertrophy. The iPTH level may play a role in the development of the ultrasonic myocardial alterations, which probably represent an early stage of uraemic cardiomyopathy.
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Bello et al. (1999) conducted an observational in End-stage renal disease treated with haemodialysis (n=45). Haemodialysis for end-stage renal disease vs. Essential hypertension and healthy controls was evaluated on Cyclic variation index (CVI) for septum (p=<0.001). Haemodialysis patients had a significantly lower cyclic variation index in the septum (-2.5% vs 11.8% and 43.2%) and posterior wall (-10.1% vs 14.2% and 46.6%) than hypertensives and controls.
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