Myocardial fibrosis and diastolic dysfunction in patients on chronic haemodialysis.
BACKGROUND
Left ventricular (LV) diastolic dysfunction is linked to myocardial collagen content in many cardiac diseases. There are no data regarding such relationship in patients with end-stage renal disease (ESRD) undergoing haemodialysis.


METHODS
Twenty-five patients with ESRD undergoing haemodialysis were studied by echocardiography. LV diastolic function was investigated by Doppler echocardiography, by analysing LV filling velocities at rest and during loading manoeuvres, which represent an estimate of LV filling pressure. According to the Doppler pattern, LV filling pressure in a given patient was judged to be normal or slightly increased or to be moderately or severely increased. The presence of myocardial fibrosis was estimated by ultrasound tissue characterization with integrated backscatter, which in diastole correlates with the collagen content of the myocardium.


RESULTS
Integrated backscatter was higher in patients with moderate or severely increased than in patients with normal or slightly increased LV filling pressure (integrated backscatter: 51.0 +/- 9.8 vs 41.6 +/- 5.6%; P = 0.008). Integrated backscatter was a strong and independent determinant of diastolic dysfunction (odds ratio = 1.212; P = 0.040).


CONCLUSIONS
Our data support the hypothesis that, in a selected population of patients with ESRD undergoing haemodialysis, myocardial fibrosis is associated with LV diastolic myocardial properties.
Losi
Maria Angela
MA
Department of Clinical Medicine, Cardiovascular & Immunological Sciences, Federico II University School of Medicine, Naples, Italy. losi@unina.it
Memoli
Bruno
B
Contaldi
Carla
C
Barbati
Giovanni
G
Del Prete
Marco
M
Betocchi
Sandro
S
Cavallaro
Massimo
M
Carpinella
Gerardo
G
Fundaliotis
Angelica
A
Parrella
Lucia-S
LS
Parisi
Valentina
V
Guida
Bruna
B
Chiariello
Massimo
M
D000328:Adult; D000368:Aged; D003971:Diastole; D015150:Echocardiography, Doppler; D005260:Female; D005355:Fibrosis; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D006435:Renal Dialysis; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D055815:Young Adult