Chronic kidney disease (CKD) is associated with increased cardiovascular morbidity and mortality. Congestive heart failure, coronary artery disease (CAD), cardiac arrhythmias and valvular heart disease are the most prevalent cardiovascular diseases in patients with CKD and account for 50% of all-cause mortality of patients with end stage renal disease.1 Particularly, congestive heart failure is the most prevalent cardiovascular condition in CKD patients and its prevalence increases as the kidney function declines. Pressure overload, as a consequence of long-standing hypertension and vascular stiffness, volume overload and CKD-related non-hemodynamic factors, such as inappropriate activation of the renin-angiotensin system, inflammation and stimulation of pro-hypertrophic and profibrogenic factors, are the main pathophysiological drivers of congestive heart failure.1 These factors along with a greater prevalence of traditional risk factors have been also associated to the pathogenesis of coronary plaque formation and rupture and reduced coronary flow reserve, peripheral artery disease and stroke. For the clinical cardiologist, the evaluation of CKD patients comprises the following areas:1. Is there structural heart disease? 2. Is there CAD?3. Atrial fibrillation and associated risk of embolic stroke4. Risk of sudden cardiac death (SCD)This section provides an overview on the use of multimodality cardiovascular imaging to diagnose and manage these cardiovascular complications.
340 Is catheter ablation of atrial fibrillation worthwhile in patients with congestive heart failure and concurrent structural heart disease?
