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      Echocardiographic Changes in Patients with Stage 3-5 Chronic Kidney Disease and Left Ventricular Diastolic Dysfunction

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          Abstract

          Background: Left ventricular (LV) diastolic dysfunction in chronic kidney disease (CKD) patients frequently leads to the development of congestive heart failure. We evaluated changes in echocardiographic parameters among CKD patients with LV diastolic dysfunction. Methods: We examined 70 ambulatory patients with CKD at stages 3-5 and 26 patients without CKD as a control group. Standard echocardiography and tissue Doppler imaging were performed on all patients. Patients with CKD were divided into two groups according to the results of lateral mitral early diastolic velocity (EmLV<sub>lat</sub>): a group with diastolic dysfunction (DD group; EmLV<sub>lat</sub> <8 cm/s) and a group without diastolic dysfunction (WDD group; EmLV<sub>lat</sub> ≥8 cm/s). Results: Compared to the patients in the WDD group, those in the DD group were characterized by lower values of mitral annular plane systolic excursion [MAPSE; 13 (11-17) vs. 14 (11-16) mm, p < 0.0001] and lateral mitral annular systolic velocity [SmLV<sub>lat</sub>; 7 (5-14) vs. 8 (5-13) cm/s, p = 0.006]. The area under the receiver operating characteristic (ROC) curve of the MAPSE level for the detection of LV diastolic dysfunction was 0.801 [95% CI 0.684-0.890, p < 0.0001], whereas a ROC-derived MAPSE value of ≤13 mm was characterized by a sensitivity of 84.4% and a specificity of 75.8% for diagnosing LV diastolic dysfunction. The only independent variable predicting LV diastolic dysfunction was MAPSE [OR = 0.39; 95% CI 0.21-0.74, p = 0.003]. Conclusion: We showed that reduced MAPSE, but not SmLV<sub>lat</sub>, is an independent predictive factor for LV diastolic dysfunction in CKD patients.

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          Most cited references 20

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          Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings.

          To determine the accuracy of echocardiographic left ventricular (LV) dimension and mass measurements for detection and quantification of LV hypertrophy, results of blindly read antemortem echocardiograms were compared with LV mass measurements made at necropsy in 55 patients. LV mass was calculated using M-mode LV measurements by Penn and American Society of Echocardiography (ASE) conventions and cube function and volume correction formulas in 52 patients. Penn-cube LV mass correlated closely with necropsy LV mass (r = 0.92, p less than 0.001) and overestimated it by only 6%; sensitivity in 18 patients with LV hypertrophy (necropsy LV mass more than 215 g) was 100% (18 of 18 patients) and specificity was 86% (29 of 34 patients). ASE-cube LV mass correlated similarly to necropsy LV mass (r = 0.90, p less than 0.001), but systematically overestimated it (by a mean of 25%); the overestimation could be corrected by the equation: LV mass = 0.80 (ASE-cube LV mass) + 0.6 g. Use of ASE measurements in the volume correction formula systematically underestimated necropsy LV mass (by a mean of 30%). In a subset of 9 patients, 3 of whom had technically inadequate M-mode echocardiograms, 2-dimensional echocardiographic (echo) LV mass by 2 methods was also significantly related to necropsy LV mass (r = 0.68, p less than 0.05 and r = 0.82, p less than 0.01). Among other indexes of LV anatomy, only measurement of myocardial cross-sectional area was acceptably accurate for quantitation of LV mass (r = 0.80, p less than 0.001) or diagnosis of LV hypertrophy (sensitivity = 72%, specificity = 94%).(ABSTRACT TRUNCATED AT 250 WORDS)
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            Assessment of right ventricular function using two-dimensional echocardiography.

            With the use of two-dimensional echocardiography (2DE), we analyzed apical and subcostal four-chamber views for evaluation of right ventricular (RV) function in 30 individuals as compared to RV ejection fraction (RVEF) obtained by radionuclide angiography. In addition to previously reported parameters of changes in areas and chords, a new simple measurement of tricuspid annular excursion was correlated with RVEF. A close correlation was noted between tricuspid annular plane systolic excursion (TAPSE) and RVEF (r = 0.92). The RV end-diastolic area (RVEDA) and percentage of systolic change in area in the apical four-chamber view also showed close correlation with RVEF (r = -0.76 and 0.81); however, the entire RV endocardium could only be traced in about half of our patients. The end-diastolic transverse chord length and the percentage of systolic change in chord length in the apical view showed a poor correlation with RVEF. The correlation between RVEF and both areas and chords measured in the subcostal view was poor. It is concluded that the measurement of TAPSE offers a simple echocardiographic parameter which reflects RVEF. This measurement is not dependent on either geometric assumptions or traceable endocardial edges. When the endocardial outlines could be traced, the apical four-chamber view was superior to the subcostal view in assessment of RV function.
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              New Doppler echocardiographic applications for the study of diastolic function.

              Doppler echocardiography is one of the most useful clinical tools for the assessment of left ventricular (LV) diastolic function. Doppler indices of LV filling and pulmonary venous (PV) flow are used not only for diagnostic purposes but also for establishing prognosis and evaluating the effect of therapeutic interventions. The utility of these indices is limited, however, by the confounding effects of different physiologic variables such as LV relaxation, compliance and filling pressure. Since alterations in these variables result in changes in Doppler indices of opposite direction, it is often difficult to determine the status of a given variable when a specific Doppler filling pattern is observed. Recently, color M-mode and tissue Doppler have provided useful insights in the study of diastolic function. These new Doppler applications have been shown to provide an accurate estimate of LV relaxation and appear to be relatively insensitive to the effects of preload compensation. This review will focus on the complementary role of color M-mode and tissue Doppler echocardiography and traditional Doppler indices of LV filling and PV flow in the assessment of diastolic function.
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                Author and article information

                Journal
                CRM
                Cardiorenal Med
                10.1159/issn.1664-5502
                Cardiorenal Medicine
                S. Karger AG
                1664-3828
                1664-5502
                2014
                December 2014
                21 November 2014
                : 4
                : 3-4
                : 234-243
                Affiliations
                aDepartment of Internal Diseases, Gastroenterology and Hepatology, University Clinical Hospital in Olsztyn, and bDepartment of Internal Diseases, Gastroenterology, Cardiology and Infectiology, University of Warmia and Mazury in Olsztyn, Olsztyn, and cDepartment of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
                Author notes
                *Leszek Gromadziński, MD, PhD, Department of Internal Diseases, Gastroenterology and Hepatology, University Clinical Hospital in Olsztyn, Warszawska 30, PL-10-082 Olsztyn (Poland), E-Mail lgol@op.pl
                Article
                369106 PMC4299174 Cardiorenal Med 2014;4:234-243
                10.1159/000369106
                PMC4299174
                25737688
                © 2014 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 2, Tables: 4, Pages: 10
                Categories
                Original Paper

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