Redefinition of uremic cardiomyopathy by contrast-enhanced cardiac magnetic resonance imaging

Mark, P.B. , Johnston, N., Groenning, B.A., Foster, J.E., Blyth, K.G., Martin, T.N., Steedman, T., Dargie, H.J. and Jardine, A.G. (2006) Redefinition of uremic cardiomyopathy by contrast-enhanced cardiac magnetic resonance imaging. Kidney International, 69(10), pp. 1839-1845. (doi:10.1038/sj.ki.5000249)

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Abstract

Patients with end stage renal failure (ESRF) have an increased risk of premature cardiovascular disease. Left ventricular (LV) abnormalities, so called 'uremic cardiomyopathy', are associated with poorer outcome. Cardiac magnetic resonance imaging (CMR) accurately defines LV dimensions and identifies underlying myocardial pathology. We studied the relationship between LV function and myocardial pathology in ESRF patients with CMR. A total of 134 patients with ESRF underwent CMR. LV function was assessed with further images acquired after gadolinium-diethylentriaminepentaacetic acid (DTPA). The presence of myocardial fibrosis was indicated by late gadolinium enhancement (LGE). Two main myocardial pathologies were identified. A total of 19 patients (14.2%) displayed 'subendocardial LGE' representing myocardial infarction, which was associated with conventional cardiovascular risk factors including a history of ischemic heart disease (IHD) (P<0.001), hypercholesterolemia (P<0.05), and diabetes (P<0.01). Patients with subendocardial LGE had greater LV mass (P<0.05), LV dilation (P<0.01), and LV systolic dysfunction (P<0.001) compared to patients with no evidence of LGE. The second pattern, 'diffuse LGE', seen in 19 patients (14.2%) appeared to represent regional areas of diffuse myocardial fibrosis. Diffuse LGE was associated with greater LV mass compared to patients without LGE (P<0.01) but not systolic dysfunction. In total, 28.4% of all patients exhibited evidence of myocardial fibrosis demonstrated by LGE. In contrast to published literature describing three forms of uremic cardiomyopathy – left ventricular hypertrophy (LVH), dilation, and systolic dysfunction, we have shown that LVH is the predominant cardiomyopathy specific to uremia, while LV dilation and systolic dysfunction are due to underlying (possibly silent) ischemic heart disease.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Mark, Dr Patrick and Jardine, Professor Alan and Dargie, Professor Henry
Authors: Mark, P.B., Johnston, N., Groenning, B.A., Foster, J.E., Blyth, K.G., Martin, T.N., Steedman, T., Dargie, H.J., and Jardine, A.G.
College/School:College of Medical Veterinary and Life Sciences
College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:Kidney International
Publisher:Nature Publishing Group
ISSN:0085-2538
ISSN (Online):1523-1755
Published Online:01 March 2006

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