title: Characterisation of cardiomyopathy by cardiac and aortic magnetic resonance in patients new to hemodialysis.
abstract: OBJECTIVE
  Cardiomyopathy is a key factor in accelerated cardiovascular mortality in haemodialysis (HD) patients. We aimed to phenotype cardiac and vascular dysfunction by tagged cardiovascular magnetic resonance (CMR) imaging in patients recently commencing HD.
  
  
  METHODS
  Fifty-four HD patients and 29 age and sex-matched controls without kidney disease were studied. Left ventricular (LV) mass, volumes, ejection fraction (EF), concentric remodelling, peak-systolic circumferential strain (PSS), peak diastolic strain rate (PDSR), LV dyssynchrony, aortic distensibility and aortic pulse wave velocity were determined.
  
  
  RESULTS
  Global systolic function was reduced (EF 51 ± 10%, HD versus 59 ± 5%, controls, p < 0.001; PSS 15.9 ± 3.7% versus 19.5 ± 3.3%, p < 0.001). Diastolic function was decreased (PDSR 1.07 ± 0.33s(-1) versus 1.31 ± 0.38s(-1), p = 0.003). LV mass index was increased (63[54,79]g/m(2) versus 46[42,53]g/m(2), p < 0.001). Anteroseptal reductions in PSS were apparent. These abnormalities remained prevalent in the subset of HD patients with preserved EF >50% (n = 35) and the subset of HD patients without diabetes (n = 40). LV dyssynchrony was inversely correlated to diastolic function, EF and aortic distensibility. Diastolic function was inversely correlated to LV dyssynchrony, concentric remodelling, age and aortic pulse wave velocity.
  
  
  CONCLUSIONS
  Patients new to HD have multiple cardiac and aortic abnormalities as characterised by tagged CMR. Cardio-protective interventions are required from initiation of therapy.
  
  
  CONCLUSIONS
  • First characterisation of cardiomyopathy by tagged CMR in haemodialysis patients. • Diastolic function was correlated to LV dyssynchrony, concentric remodelling and aortic PWV. • Reductions in strain localised to the septal and anterior wall. • Bioimpedance measures were unrelated to LV strain, suggesting volume-independent pathogenetic mechanisms. • Multiple abnormalities persisted in the HD patient subset with preserved EF or without diabetes.
authors.affiliation: Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK. a.odudu@manchester.ac.uk.|National Institute for Health Research Clinical Lecturer in Nephrology, Institute of Cardiovascular Sciences, Manchester Academic Health Science Centre, University of Manchester, Core Technology Facility, 46 Grafton Street, Manchester, M13 9NT, UK. a.odudu@manchester.ac.uk.|Division of Medical Sciences, University of Nottingham, Nottingham, UK. a.odudu@manchester.ac.uk.|Department of Renal Medicine, Royal Derby Hospital, Derby, UK. a.odudu@manchester.ac.uk.
authors.forename: Aghogho
authors.identifier: http://orcid.org/0000-0002-4863-1560
authors.initials: A
authors.lastname: Odudu
authors.affiliation: Division of Medical Sciences, University of Nottingham, Nottingham, UK.|Department of Renal Medicine, Royal Derby Hospital, Derby, UK.
authors.forename: Mohamed Tarek
authors.initials: MT
authors.lastname: Eldehni
authors.affiliation: Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.|National Institute for Health Research Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK.
authors.forename: Gerry P
authors.initials: GP
authors.lastname: McCann
authors.affiliation: Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.|National Institute for Health Research Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Horsfield
authors.affiliation: Department of Renal Medicine, Royal Derby Hospital, Derby, UK.|Clinic for Transplant-Immunology and Nephrology, University Hospital Basel, Basel, Switzerland.
authors.forename: Tobias
authors.initials: T
authors.lastname: Breidthardt
authors.affiliation: Division of Medical Sciences, University of Nottingham, Nottingham, UK.|Division of Nephrology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: McIntyre
mesh_terms: D001011:Aorta / Q000000981:diagnostic imaging*; D009202:Cardiomyopathies / Q000175:diagnosis* / Q000209:etiology; D003971:Diastole; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D063177:Pulse Wave Analysis; D006435:Renal Dialysis; D013318:Stroke Volume; D013599:Systole; D016277:Ventricular Function, Left
keywords: Aortic distensibility; Cardiac magnetic resonance; Cardiomyopathy; Dyssynchrony; Hemodialysis