Στεφανιαία εφεδρεία ροής και διαστολική απόδοση της αριστερής κοιλίας σε ασθενείς με χρόνια νεφρική νόσο

Abstract

lntroduction-Aim of the studv: Chronic kidney disease (CKD) is related to higher risk for cardiovasular related morbidity and mortality. lt seems that this risk is higher even in the presence of early abnormal indices related to functionality of the left ventricle orland abnormal coronary flow reserve (CFR). Aim of this study was a) to investigate diastolic dysfunction and CFR after dipyridamole infusion in CKD patients, b) to inspect changes in diastolic dysfunction of the left ventricle after dipyridamole infusion in these patients and c) to compare the aforementioned indices between CKD patients and healthy controls, as also between patients with CKD and patients with a hisotry of renal transplantation Tx. Materials and methods: This study included 60 CKD patients from the outpatient CKD clinic of University Hospital of loannina, 30 healthy controls and 50 patients with Tx history. All patients and healthy controls were evaluated thoroughly (clinical examination, lab exams and echocardiographic evaluation). The echocardiographic evaluation included transthoracic echocardiogram, dipyridamole infusion for coronary flow reserve (CFR) evaluation in the left anterior descending coronary artery and at the end of the this stress test, a new transthoracic echocardiogram.ln a subgroup of Tx patients, the whole evaluation was repeated after 3 years. Results: Mean CFR value [t standard deviation (SD)] for CKD patients was 2.98 (t0.83).Deformation related echocardiographic indices urere normal [mean values (t) SD: GLS -20.5 (t3.1)o/o, τWlsT s.07(t4.41)", UNTW|Sτ -69.2(t30)"/sec]' Patients with advanced CKD (GFR<3omllminl1'73m2), had bigger left ventricle mass (p<0.037), without any other differences comparing to other patients as far as echocardiographic indices related to systolic and diastoliο left ventricular function were concerned. CKD patients had lower CFR comparing to healthy controls. There \rvere no differences of statistical importance between these two populations, in left ventricular functional indices. After dipyridamole infusion, there was a significant improvement (p<0.05) in all left venticular functionality related echoοardiographic indices in both populations.Tx patients had bigger left atrial volume (p=0.014), lower CFR mean value (p=0.007) and better left ventricular diastolic function shown by UΝTW|SΤ (p=0.035) comparing to CKD patients. There ιΛ/ere no differenοes in echocardiographic indices'changes before and after dipyridamole infusion. ln Tx patients that were re-evaluated after 3 years (N=45), a deterioration was shown in most of echocardiographic indices [increase in left ventricuΙat mass (ρ=0.009), decrease in left ventricular ejection fraction (p=0.001), increase in E/e'(p=0.002), deterioration in TW|ST (p=0.002) and UNTW|ST (p=9.935μ. Conclusion: Patients with CKD have lower CFR values comparing to healthy controls and higher than patients with a history of Tx. Tx patients had better left ventricular diastolic function than CKD patients. There \Λrere no significant differrences in various echocardiographiο indices before and after dipyridamole infusion, in all subgroups of patients in this study. Larger-scale studies are mandatory to clarify the clinical importance of various echocardiographic indices in different CKD stages.