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Defining Myocardial Abnormalities Across the Stages of Chronic Kidney Disease: A Cardiac Magnetic Resonance Imaging Study.

Authors :
Hayer, Manvir K.
Radhakrishnan, Ashwin
Price, Anna M.
Liu, Boyang
Baig, Shanat
Weston, Christopher J.
Biasiolli, Luca
Ferro, Charles J.
Townend, Jonathan N.
Steeds, Richard P.
Edwards, Nicola C.
Source :
JACC: Cardiovascular Imaging; Nov2020, Vol. 13 Issue 11, p2357-2367, 11p
Publication Year :
2020

Abstract

A proof of concept cross-sectional study investigating changes in myocardial abnormalities across stages of chronic kidney disease (CKD). Characterizing noninvasive markers of myocardial fibrosis on cardiac magnetic resonance, echocardiography, and correlating with biomarkers of fibrosis, myocardial injury, and functional correlates including exercise tolerance. CKD is associated with an increased risk of cardiovascular death. Much of the excess mortality is attributed to uremic cardiomyopathy, defined by increased left ventricular hypertrophy, myocardial dysfunction, and fibrosis. The prevalence of these abnormalities across stages of CKD and their impact on cardiovascular performance is unknown. A total of 134 nondiabetic, pre-dialysis subjects with CKD stages 2 to 5 without myocardial ischemia underwent cardiac magnetic resonance (1.5-T) including; T 1 mapping (biomarker of diffuse fibrosis), T 2 mapping (edema), late gadolinium enhancement, and assessment of aortic distensibility. Serum biomarkers including collagen turnover (P1NP, P3NP), troponin T, and N-terminal pro–B-type natriuretic peptide were measured. Cardiovascular performance was quantified by bicycle cardiopulmonary exercise testing and echocardiography. Native myocardial T 1 times increased incrementally from stage 2 to 5 (966 ± 21 ms vs. 994 ± 33 ms; p < 0.001), independent of hypertension and aortic distensibility. Left atrial volume, E/eʹ, N-terminal pro–B-type natriuretic peptide, P1NP, and P3NP increased with CKD stage (p < 0.05), while effort tolerance (% predicted VO 2 Peak, %VO 2 VT) decreased (p < 0.001). In multivariable linear regression models, estimated glomerular filtration rate was the strongest predictor of native myocardial T 1 time (p < 0.001). Native myocardial T 1 time, left atrial dilatation, and high-sensitivity troponin T were independent predictors of % predicted VO 2 Peak (p < 0.001). Imaging and serum biomarkers of myocardial fibrosis increase with advancing CKD independent of effects of left ventricular afterload and might be a key intermediary in the development of uremic cardiomyopathy. Further studies are needed to determine whether these changes lead to the increased rates of heart failure and death in CKD. (Left Ventricular Fibrosis in Chronic Kidney Disease [FibroCKD]; NCT03176862) [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
1936878X
Volume :
13
Issue :
11
Database :
Supplemental Index
Journal :
JACC: Cardiovascular Imaging
Publication Type :
Academic Journal
Accession number :
146615591
Full Text :
https://doi.org/10.1016/j.jcmg.2020.04.021