title: Cardiac remodelling and functional alterations in mild-to-moderate renal dysfunction: comparison with healthy subjects.
abstract: BACKGROUND
  Left ventricular (LV) hypertrophy (LVH) and reduced LV function correlate with poor prognosis in patients with chronic kidney disease (CKD). Our aim is to investigate whether mild-to-moderate CKD is associated with cardiac abnormalities.
  
  
  METHODS
  Echocardiography, including tissue Doppler imaging, was performed in 103 patients with CKD at stages 2-3 and 4-5, and in 53 healthy controls. The systolic (s') and diastolic myocardial velocity (e'), and the transmitral diastolic flow velocity (E) were measured, and E/e' was calculated.
  
  
  RESULTS
  Patients with chronic kidney disease had higher mean E/e' than controls (mean E/e': controls 5·00 ± 1·23 versus CKD 4-5 6·36 ± 1·71, P<0·001 and versus CKD 2-3 5·69 ± 1·47, P = 0·05), indicating altered diastolic function in the patients. The CKD groups showed lower longitudinal systolic function than controls, as assessed by atrio-ventricular plane displacement and s' (mean s': controls 11·5 ± 1·9 cm s(-1) versus CKD 4-5 10·4 ± 2·1 cm s(-1) , P = 0·03 and versus CKD 2-3 10·4 ± 2·1 cm s(-1) , P = 0·02). The prevalence of LVH was higher in patients with CKD than in controls (controls 13% versus CKD 4-5 37%, P = 0·006 and versus CKD 2-3 30%, P = 0·03).
  
  
  CONCLUSIONS
  Alterations in systolic and diastolic myocardial function can be seen in mild-to-moderate CKD compared with controls, indicating that cardiac involvement starts early in CKD, which may be a precursor of premature cardiac morbidity.
authors.affiliation: Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Asp
authors.forename: Carin
authors.initials: C
authors.lastname: Wallquist
authors.forename: Anette
authors.initials: A
authors.lastname: Rickenlund
authors.forename: Britta
authors.initials: B
authors.lastname: Hylander
authors.forename: Stefan H
authors.initials: SH
authors.lastname: Jacobson
authors.forename: Kenneth
authors.initials: K
authors.lastname: Caidahl
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Eriksson
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003971:Diastole; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D012307:Risk Factors; D012720:Severity of Illness Index; D013548:Sweden / Q000453:epidemiology; D013599:Systole; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling
keywords: chronic kidney disease; left ventricular diastolic function; left ventricular mass; left ventricular systolic function; tissue Doppler imaging
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