Inferior vena cava diameter determines left ventricular geometry in continuous ambulatory peritoneal dialysis patients: An echocardiographic study

Department of Internal Medicine, Marmara University School of Medicine, Tophanelioglu Cad. No: 13/15, Altunizade, 34660 Istanbul, Turkey.
Nephrology Dialysis Transplantation (Impact Factor: 3.58). 11/2003; 18(10):2128-33. DOI: 10.1093/ndt/gfg298
Source: PubMed


Changes in left ventricular (LV) geometry are frequent in patients with continuous ambulatory peritoneal dialysis (CAPD). Geometric adaptation of LV to various stimuli was reported to have adverse prognosis. This study aimed to identify independent risk factors, which contribute to the development of LV geometric remodelling in CAPD patients.
The left ventricles of 69 CAPD patients were classified echocardiographically into four different geometric patterns on the basis of LV mass and relative wall thickness. With respect to volume factor, we measured inferior vena cava (IVC) diameter and its decrease on deep inspiration [collapsibility index (CI)] by echocardiography. We modelled a stepwise multiple regression analysis to determine the predictors of LV geometry.
All four geometric models of LV were identified in our group of 69 CAPD patients. Eccentric left ventricular hypertrophy (eLVH) was observed in 32 (46%), concentric LVH (cLVH) in 19 (28%), normal geometry (NG) in 10 (14%) and concentric remodelling (CR) in eight (12%) CAPD patients. Mean IVC index of the eLVH group (10.72 +/- 2.19 mm/m(2)) was significantly higher than corresponding indexes of NG (7.90 +/- 1.54 mm/m(2)), CR (8.51 +/- 1.28 mm/m(2)) and cLVH (8.04 +/- 2.00 mm/m(2)) groups (P < 0.001 for each comparisons). The eLVH group also had significantly lower mean CI value (0.48 +/- 0.11) than CR (0.58 +/- 0.09) and cLVH (0.57 +/- 0.07) groups (ANOVA P = 0.008). Stepwise multiple regression analysis revealed that IVC index, CI and haemoglobin were the independent predictors of LV geometric stratification (R2 = 0.36, P < 0.001).
Hypervolaemia, identified by IVC index and CI, and anaemia contribute independently to LV geometry in CAPD patients. Echocardiography as a non-invasive tool is not only useful to determine LV geometry, but also to assess the volume status of CAPD patients.

Download full-text


Available from: Mehmet Koc, Mar 19, 2014
  • Source
    • "There was no common iliac artery corresponding to that of humans, which arises from the aorta and branches off into the external and internal iliac arteries. Although differences in vascular diameter, morphology, and branching pattern between micropigs and human [2,19,25,30,39] can be overcome with modern surgical techniques at the time of transplantation, there is the possibility that the function of the related micropig organs could be compromised in human systems following transplantation. Thus, further studies are needed to evaluate and compare micropig organ function with that of humans. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Due primarily to the increasing shortage of allogeneic donor organs, xenotransplantation has become the focus of a growing field of research. Currently, micropigs are the most suitable donor animal for humans. However, no standard method has been developed to evaluate the systemic vascular anatomy of micropigs and standard reference values to aid in the selection of normal healthy animals as potential organ donors are lacking. Using 64-channel multidetector row computed tomographic angiography (MDCTA), we evaluated morphological features of the major systemic vessels in micropigs and compared our results to published human data. The main vasculature of the animals was similar to that of humans, except for the iliac arterial system. However, diameters of the major systemic vessels were significantly different between micropigs and humans. Specifically, the diameter of the aortic arch, abdominal aorta, external iliac artery, and femoral artery, were measured as 1.50 ± 0.07 cm, 0.85 ± 0.06 cm, 0.52 ± 0.05 cm, and 0.48 ± 0.05 cm, respectively, in the micropigs. This MDCTA data for micropig major systemic vessels can be used as standard reference values for xenotransplantation studies. The use of 64-channel MDCTA enables accurate evaluation of the major systemic vasculature in micropigs.
    Full-text · Article · Sep 2011 · Journal of veterinary science (Suwŏn-si, Korea)
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Left ventricular hypertrophy in chronic kidney disease Chronic kidney disease (CKD) is associated with increased cardiovascular (CV) risk. Left ventricular (LV) hypertrophy (LVH), together with coronary artery disease, has been considered the main target of intervention. LVH is highly prevalent in CKD even in early stages, as compared to general non-selected population. This is mainly due to the multifactorial pathogenesis of LVH in renal patients where both haemodynamic and non-haemodynamic stimuli synergically act inducing either an increase in left ventricular mass or an LV dilation. Anaemia and arterial hypertension seem to be the most important factors. Interventional studies have shown that partial correction of anaemia through epoetin, together with an arterial hyperten- sion successful therapy through renin-angiotensin system acting drugs, such as ACE-inhibitors, were able to induce a LVH regression in CKD. Indeed, the unfavourable outcome in patients with both CKD and LVH, whose survival is reduced and incidence of fatal and non-fatal CV events increased, can be reversed if LVH is regressed by therapy. The most promising strategy in CKD seems to be LVH early diagnosis through echocardiography, the correct screening of risk factors, a LVM longitudinal monitoring through echo, as well as starting treatment in the early stages of CKD, with the aim of improving general and CV prognosis for these patients. (G Ital Nefrol 2006; 23: 560-8)
    Full-text · Article ·
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: In summary, patients on PD have a vastly increased risk of cardiovascular disease. Volume overload plays a major role in its pathogenesis. Sodium restriction therefore must be advised in PD patients and supported by a patient education programme. Normovolaemia can be achieved through increased ultrafiltration rate using icodextrin or by increasing residual urine volume with loop-diuretics. Care must be taken to prevent underfilling and the preservation of RRF is crucial. Although it is tempting to assume that the survival benefit of non-dialysis patients on statin treatment will also translate to the PD population, the outcome of ongoing prospective trials is anxiously awaited. Finally, although PD may offer a survival advantage in patients initiating RRT [20,48], PD is currently under-utilized in many parts of the world [50]. © The Author [2006]. Oxford University Press. All rights reserved.
    Preview · Article · Aug 2006 · Nephrology Dialysis Transplantation
Show more