MiscellaneousDiffuse Interstitial Fibrosis and Myocardial Dysfunction in Early Chronic Kidney Disease
Section snippets
Methods
Patients were prospectively recruited from renal clinics at the Queen Elizabeth Hospital Birmingham, England, from 2012 to 2014. Inclusion criteria were CKD stage 2 (eGFR 60 to 89 ml/min/1.73 m2 with other evidence of kidney disease: proteinuria/hematuria/structural abnormality/genetic), stage 3 (eGFR 30 to 59 ml/min/1.73 m2), and stage 4 (15 to 29 ml/min/1.73 m2) with no history or symptoms of CV disease or diabetes. Estimated GFR was measured by the 4-Variable Modification of Diet in Renal
Results
In total, 129 subjects were studied across the 3 groups without significant differences in age and gender. The leading causes of renal disease were primary glomerular nephropathy (37%), adult polycystic kidney disease (21%), and quiescent vasculitis (systemic lupus erythematosus, Wegeners granulomatosis, 16%). Patient characteristics are presented in Table 1.
There were no differences in LV volumes or LVEF between groups (Table 2). LA volumes were increased in CKD compared with controls and
Discussion
This is the first study to assess diffuse interstitial fibrosis using T1-mapping CMR in patients with early CKD. Longer native T1 times correlate closely with histologic quantitation of myocardial fibrosis, based on cardiac biopsy in subjects with aortic stenosis who underwent valve replacement.8, 9 The technique is now well established and has been used to identify adverse clinical outcomes in other disease groups including diabetes,10 valvular heart disease,9 and amyloidosis.11 ECV expansion
Acknowledgment
The authors would like to thank James Hodson and Peter Nightingale for statistical support.
References (30)
- et al.
Effect of spironolactone on left ventricular systolic and diastolic function in patients with early stage chronic kidney disease
Am J Cardiol
(2010) - et al.
Effect of a reduction in glomerular filtration rate after NEphrectomy on arterial STiffness and central hemodynamics: rationale and design of the EARNEST study
Am Heart J
(2014) - et al.
Myocardial T1 mapping and extracellular volume quantification: a Society for Cardiovascular Magnetic Resonance (SCMR) and CMR Working Group of the European Society of Cardiology consensus statement
J Cardiovasc Magn Reson
(2013) - et al.
Effectiveness of late gadolinium enhancement to improve outcomes prediction in patients referred for cardiovascular magnetic resonance after echocardiography
J Cardiovasc Magn Reson
(2013) - et al.
Prognostic role of subclinical left ventricular abnormalities and impact of transplantation in chronic kidney disease
Am Heart J
(2007) - et al.
Association of myocardial deformation with mortality independent of myocardial ischemia and left ventricular hypertrophy
JACC Cardiovasc Imaging
(2009) - et al.
Differentiation between pathologic and physiologic left ventricular hypertrophy by tissue Doppler assessment of long-axis function in patients with hypertrophic cardiomyopathy or systemic hypertension and in athletes
Am J Cardiol
(2001) - et al.
Clinical and pathologic characteristics of dilated cardiomyopathy in hemodialysis patients
Kidney Int
(2005) - et al.
Effect of spironolactone on left ventricular mass and aortic stiffness in early-stage chronic kidney disease: a randomized controlled trial
J Am Coll Cardiol
(2009) - et al.
Subclinical myocardial inflammation and diffuse fibrosis are common in systemic sclerosis—a clinical study using myocardial T1-mapping and extracellular volume quantification
J Cardiovasc Magn Reson
(2014)
Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis
Lancet
Associations between kidney function and subclinical cardiac abnormalities in CKD
J Am Soc Nephrol
Comparison of magnetic resonance feature tracking for systolic and diastolic strain and strain rate calculation with spatial modulation of magnetization imaging analysis
J Magn Reson Imaging
Extracellular volume imaging by magnetic resonance imaging provides insights into overt and sub-clinical myocardial pathology
Eur Heart J
Human non-contrast T1 values and correlation with histology in diffuse fibrosis
Heart
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