scholarly journals Left-sided heart disease and risk of death in patients with end-stage kidney disease receiving haemodialysis: an observational study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Anna Axelsson Raja ◽  
Peder E. Warming ◽  
Ture L. Nielsen ◽  
Louis L. Plesner ◽  
Mads Ersbøll ◽  
...  
Keyword(s):  
Heart Disease ◽  
Kidney Disease ◽  
Left Ventricular ◽  
Valve Disease ◽  
Left Ventricular Ejection ◽  
Clinical Consequence ◽  
End Stage Kidney Disease ◽  
Risk Of Death ◽  
Echocardiographic Assessment ◽  
End Stage

Abstract Background Cardiovascular disease is the most common cause of death in patients with end-stage kidney disease on haemodialysis. The potential clinical consequence of systematic echocardiographic assessment is however not clear. In an unselected, contemporary population of patients on maintenance haemodialysis we aimed to assess: the prevalence of structural and functional heart disease, the potential therapeutic consequences of echocardiographic screening and whether left-sided heart disease is associated with prognosis. Methods Adult chronic haemodialysis patients in two large dialysis centres had transthoracic echocardiography performed prior to dialysis and were followed prospectively. Significant left-sided heart disease was defined as moderate or severe left-sided valve disease or left ventricular ejection fraction (LVEF) ≤40%. Results Among the 247 included patients (mean 66 years of age [95%CI 64–67], 68% male), 54 (22%) had significant left-sided heart disease. An LVEF ≤40% was observed in 31 patients (13%) and severe or moderate valve disease in 27 (11%) patients. The findings were not previously recognized in more than half of the patients (56%) prior to the study. Diagnosis had a potential impact on management in 31 (13%) patients including for 18 (7%) who would benefit from initiation of evidence-based heart failure therapy. After 2.8 years of follow-up, all-cause mortality among patients with and without left-sided heart disease was 52 and 32% respectively (hazard ratio [HR] 1.95 (95%CI 1.25–3.06). A multivariable adjusted Cox proportional hazard analysis showed that left-sided heart disease was an independent predictor of mortality with a HR of 1.60 (95%CI 1.01–2.55) along with age (HR per year 1.05 [95%CI 1.03–1.07]). Conclusion Left ventricular systolic dysfunction and moderate to severe valve disease are common and often unrecognized in patients with end-stage kidney failure on haemodialysis and are associated with a higher risk of death. For more than 10% of the included patients, systematic echocardiographic assessment had a potential clinical consequence.

4309Structural or functional left sided heart disease found on echocardiographic screening is associated with a higher risk of death in patients with end stage renal disease receiving haemodialysis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Axelsson Raja ◽  
T Lange Nielsen ◽  
L L Plesner ◽  
P E Warming ◽  
M Ersboll ◽  
...  
Keyword(s):  
Heart Disease ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Structural Heart Disease ◽  
Left Ventricular ◽  
Valve Disease ◽  
Left Ventricular Ejection ◽  
Risk Of Death ◽  
Stage Renal Disease ◽  
End Stage

Abstract Introduction Cardiovascular disease is the leading cause of death in patients with end-stage renal disease on haemodialysis. Guidelines recommend echocardiography in all incident patients on dialysis and every three years, or when considered for kidney transplantation. The prognostic value of significant valve disease or reduced systolic function detected by echocardiographic screening is however not clear. Purpose We aimed to test the hypothesis that structural heart disease in an unselected, contemporary population of patients on maintenance dialysis is associated to a higher risk of death. Methods Adult chronic haemodialysis patients in two large dialysis centers had transthoracic echocardiography performed immediately prior to dialysis and were followed prospectively. Significant structural or functional left sided heart disease was defined as moderate or severe left-sided valve disease or left ventricular ejection fraction (LVEF) ≤40%. Results Among the 247 included patients (66 [IQR 64–67] years of age, 68% male), 54 (22%) had significant structural or functional left sided heart disease. An LVEF ≤40% was observed in 31 patients (13%). Severe or moderate aortic stenosis was present in 4 (2%) and 16 (7%) patients respectively, moderate mitral regurgitation in 4 (2%) patients and mitral stenosis in one (0.4%) patient. In more than half of the patients (56%), significant structural or functional left sided heart disease was not recognized prior to the study. After 2.8 years of follow-up, all-cause mortality was 52% for patients with significant heart disease and 32% for patients without significant structural heart disease (hazard ratio [HR] 1.95 (95% CI 1.25–3.06) (Figure). On multivariable adjusted Cox proportional hazard analysis, including age, sex, ischemic heart disease, diabetes, hypertension and time on dialysis, structural heart disease was an independent predictor of mortality with a HR of 1.60 (95% CI 1.01–2.55) along with age (HR per year 1.05 [95% CI 1.03–1.07]). Kaplan-Meier estimate of survival Conclusion Left ventricular systolic dysfunction and moderate to severe valve disease are common and often unrecognized in patients with end-stage renal failure on haemodialysis and are associated with a higher risk of death.

Incidence of Ischaemic Heart Disease in Men and Women With End-Stage Kidney Disease: A Cohort Study

2020 ◽  
Vol 29 (10) ◽  
pp. 1517-1526 ◽  
Author(s):  
Emma O'Lone ◽  
Patrick J. Kelly ◽  
Philip Masson ◽  
Sradha Kotwal ◽  
Martin Gallagher ◽  
...  
Keyword(s):  
Cohort Study ◽  
Heart Disease ◽  
Kidney Disease ◽  
Ischaemic Heart Disease ◽  
End Stage Kidney Disease ◽  
Men And Women ◽  
End Stage

scholarly journals COMBINED MITRAL AND TRICUSPID STENOSIS IN 47-YEAR OLD RHEUMATIC VALVULAR HEART DISEASE PATIENT: A CASE REPORT

2020 ◽  
Vol 14 (2) ◽  
pp. 153-156
Author(s):  
*Ejeagba OO ◽  
◽  
*Ayoola YA ◽  
*Ejeh AB ◽  
*Adamu A ◽  
...  
Keyword(s):  
Heart Disease ◽  
Left Atrium ◽  
Valvular Heart Disease ◽  
Systolic Dysfunction ◽  
Disease Patient ◽  
Hypertensive Heart Disease ◽  
Left Ventricular ◽  
Valve Disease ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

Background: Rheumatic valvular heart disease is a common complication of rheumatic fever; however combined mitral and tricuspid stenosis is an extremely rare form of multi-valve disease presentation. Case Presentation: We report a case of combined mitral and tricuspid stenosis from rheumatic heart disease (RHD) in a 47-year-old woman who was being managed for hypertensive heart disease (HHDx) on anti-hypertensives for 2yrs prior to presentation. However, on further review with transthoracic echocardiography (TTE), she was found to have thickened mitral valve and hockey stick appearance with dilated left atrium (dimension of 60mm) and reduced left ventricular ejection fraction (LVEF) of 45%. A repeat TTE done 8 years after the first one showed a severely dilated left atrium (LAD 71mm) with estimated area of 55.4cm2; moderate mitral stenosis and severe tricuspid stenosis with moderate TR. The LVEF was 29% with a severe right ventricular (RV) systolic dysfunction (TAPSE of 9mm). Patient is being managed conservatively due to economic constraints and the likelihood of very poor surgical outcome due to severe biventricular dysfunction. Conclusion: The case is reported for its rarity as well as the importance of interval evaluation of unaffected valves in a setting of single valve disease for early detection and possible prompt treatment and intervention.

scholarly journals Screening for coronary heart disease at the starting of dialysis could lead End-Stage Kidney Disease (ESKD) patients to be better prognosis

2013 ◽  
Vol 34 (suppl 1) ◽  
pp. P3094-P3094
Author(s):  
N. Joki ◽  
T. Asakawa ◽  
Y. Tanaka ◽  
T. Hayashi ◽  
M. Iwasaki ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Kidney Disease ◽  
End Stage Kidney Disease ◽  
End Stage

scholarly journals Left ventricular geometric patterns in end-stage kidney disease: Determinants and course over time

2018 ◽  
Vol 22 (3) ◽  
pp. 359-368 ◽  
Author(s):  
Menso J. Nubé ◽  
Tiny Hoekstra ◽  
Volkan Doganer ◽  
Michiel L. Bots ◽  
Peter J. Blankestijn ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Left Ventricular ◽  
End Stage Kidney Disease ◽  
Geometric Patterns ◽  
End Stage ◽  
Over Time

Left ventricular stiffness in paediatric patients with end-stage kidney disease

2020 ◽  
Vol 35 (6) ◽  
pp. 1051-1060
Author(s):  
Ann Wing-man Choi ◽  
Nai-chung Fong ◽  
Vivian Wing-yi Li ◽  
Tsz-wai Ho ◽  
Eugene Yu-hin Chan ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Left Ventricular ◽  
End Stage Kidney Disease ◽  
Paediatric Patients ◽  
Left Ventricular Stiffness ◽  
End Stage

scholarly journals The cardiovascular determinants of physical function in patients with end-stage kidney disease on haemodialysis

2020 ◽  
Author(s):  
Sherna F. Adenwalla ◽  
Roseanne E. Billany ◽  
Daniel S. March ◽  
Gaurav S. Gulsin ◽  
Hannah M. L. Young ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Ejection Fraction ◽  
Physical Function ◽  
Left Ventricular ◽  
End Stage Kidney Disease ◽  
Exercise Interventions ◽  
Native T1 ◽  
Dialysis Vintage ◽  
Lv Ejection Fraction ◽  
End Stage

AbstractPatients with end-stage kidney disease (ESKD) are often sedentary and decreased functional capacity associates with mortality. The relationship between cardiovascular disease (CVD) and physical function has not been fully explored. Understanding the relationships between prognostically relevant measures of CVD and physical function may offer insight into how exercise interventions might target specific elements of CVD. 130 patients on haemodialysis (mean age 57 ± 15 years, 73% male, dialysis vintage 1.3 years (0.5, 3.4), recruited to the CYCLE-HD trial (ISRCTN11299707), underwent cardiovascular phenotyping with cardiac MRI (left ventricular (LV) structure and function, pulse wave velocity (PWV) and native T1 mapping) and cardiac biomarker assessment. Participants completed the incremental shuttle walk test (ISWT) and sit-to-stand 60 (STS60) as field-tests of physical function. Linear regression models identified CV determinants of physical function measures, adjusted for age, gender, BMI, diabetes, ethnicity and systolic blood pressure. Troponin I, PWV and global native T1 were univariate determinants of ISWT and STS60 performance. NT pro-BNP was a univariate determinant of ISWT performance. In multivariate models, NT pro-BNP and global native T1 were independent determinants of ISWT and STS60 performance. LV ejection fraction was an independent determinant of ISWT distance. However, age and diabetes had the strongest relationships with physical function. In conclusion, NT pro-BNP, global native T1 and LV ejection fraction were independent CV determinants of physical function. However, age and diabetes had the greatest independent influence. Targeting diabetic care may ameliorate deconditioning in these patients and a multimorbidity approach should be considered when developing exercise interventions.

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