Is cardiac biomarkers and left ventricular function affected by chronic kidney disease?

BackgroundCardiovascular disease is the leading cause of death in patients with chronic kidney disease (CKD). These patients may have high level of cardiac troponins in their serum irrelevant to acute coronary syndrome (ACS) that could have profound impact on patient's morbidity and mortality.ObjectivesThe aim of this study was to assess the relation between level of serum creatinine (Cr) and cardiac troponins T and I, and left ventricular (LV) function (as defined by LV ejection fraction) in non-dialysis and non-acute coronary syndrome CKD patients.Materials and MethodsThis is a prospective cross sectional study that includes 150 non-dialysis CKD patients without history of ACS in at least 1 month before the beginning of the study. Patients with history of CKD (serum Cr ≥1.5 mg/dl) of more than 6 months were selected. Patients with advanced multi-organ disease (lung disease, liver disease, cerebrovascular disease and peripheral vascular disease) and history of dialysis were excluded from the study. In each patient blood sample was obtained for analyzing serum Cr and cardiac troponin T and I (cTnT and cTnI). Also LV ejection fraction (LVEF) was measured by echocardiography in the same session.ResultThere was a positive non-parametric relation between serum Cr and cTnT (p = 0.028). However there were no relation between serum Cr, cTnI (p = 0.57) and LVEF (p = 0.188).ConclusionIn patients with CKD, serum Cr level has an impact on cTnT, but has no impact on cTnI and LVEF.     

Is the left ventricular filling pattern restrictive in cardiac amyloidosis?

Abstracts

Echo/Doppler assessment of morphologic and functional abnormalities in restrictive and infiltrative cardiomyopathy     

Caseous mitral annular calcification: Is it a benign condition?

Caseous mitral annular calcification (CMAC) is a variant of mitral annular calcification (MAC) with a central liquefaction necrosis. The echocardiographic prevalence of CMAC is approximately 0.6% in patients with MAC and 0.06–0.07% in large series of patients of all ages. However, the prevalence in necropsy series has been reported to be 2.7%, which indicates that this condition is yet under-recognized. Furthermore CMAC is probably underappreciated as a source of potentially serious conditions. We report a case of recent stroke associated with CMAC diagnosed by trans-thoracic and confirmed by trans-esophageal echocardiogram (TEE). The importance of correct diagnosis of CMAC extends beyond the possible complications; since several misdiagnoses of CMAC as abscesses and cardiac tumors have been reported leading to inappropriate interventions.     

Is carotid atherosclerosis more important in patients with mitral annular calcification than in those without?

It has been suggested that mitral annular calcification (MAC) may be a manifestation of generalized atherosclerosis. However, how the incidence and extent of coronary artery disease (CAD) are affected by the coexistence of carotid atherosclerosis (CAS) in patients with versus without MAC have not yet been studied. We studied 101 patients with echocardiographic MAC and 52 controls without MAC to investigate the clinical impact of CAS on the frequency and severity (defined as the number of obstructed vessels) of CAD in patients with MAC. Carotid Doppler ultrasonographic examination was performed on all patients before coronary angiography. In patients with both MAC and CAS, the incidences of CAD and multivessel disease (> or = 2 vessel or left main coronary artery disease) were significantly higher than in the control group with CAS alone (91% versus 68%, P = 0.008 and 76% versus 44%, P = 0.004, respectively). On the other hand, among study and control patients without CAS, although the frequencies of CAD and multivessel disease were higher in patients with MAC, interestingly, the differences were not statistically significant (37% versus 58% and 15% versus 26%, respectively, P > 0.05 for both). Stepwise multiple logistic regression analysis revealed that CAS (P < 0.001), MAC (P < 0.01) and, to a limited extent hypertension (P = 0.054), were independent predictors for the presence of CAD. In conclusion, the coexistence of CAS is more important in patients with MAC than in those without as it provides valuable information about the incidence and severity of underlying CAD. In cases with MAC but without CAS, MAC could be caused by factors other than atherosclerosis.     

Can the amplitude of mitral annulus motion be used in the assessment of left ventricular systolic function in patients with left ventricular wall thickness in the upper limit of normal to mild hypertrophy?

BACKGROUND:

Mitral annulus motion (MAM) obtained by echocardiography can be used in the assessment of left ventricular systolic function (LVSF). However, it has been shown that the amplitude of MAM is decreased in patients with left ventricular wall thickness (LVWT) greater than 14 mm.

OBJECTIVE:

To study if the amplitude of MAM can be used in the assessment of LVSF in patients with LVWT in the upper limit of normal to mild hypertrophy (12 mm to 14 mm).

METHODS:

Eighteen consecutive patients with LVWT of 12 mm to 14 mm were compared to 18 age- and sex-matched patients with LVWT less than 12 mm.

RESULTS:

There was no significant difference between the amplitude of MAM in the two groups.

CONCLUSIONS:

MAM can be used in the assessment of LVSF in patients with LVWT in the upper limit of normal to mild hypertrophy and be related to reference values.     

Is left ventricular diastolic function an independent marker of prognosis after acute myocardial infarction?

BACKGROUND: In addition to clinical risk markers, indices of left ventricular (LV) systolic function are valuable prognostic markers after acute myocardial infarction (MI). Previous studies have also suggested that LV diastolic function may contribute with prognostic information. The present study assessed whether this assumption applies to a large population of patients with acute MI who underwent thrombolytic therapy. METHODS AND RESULTS: 520 out of 608 patients participating in the ATTenuation by Adenosine of Cardiac Complications (ATTACC) study, with an ST-elevation acute MI underwent two-dimensional and Doppler echocardiographic examination at 4 (range 2-10) days after admission. During the follow-up period of 31 (S.D. +/- 11) months, cardiovascular death occurred in 57 (11%) patients, nonfatal acute MI occurred in 77 (15%), and 124 (24%) patients suffered a combined cardiovascular end-point (either nonfatal acute MI or cardiovascular death). Univariate regression analysis showed that all indices of LV systolic function predicted cardiovascular death and combined cardiovascular end-points. Regarding LV diastolic function only a restrictive filling pattern predicted cardiovascular death. In a multistep multivariate regression analysis in which the variables were introduced in a hierarchic order age, history of systemic hypertension, wall motion score index (WMSi), and history of previous MI and diabetes mellitus were independent predictors of cardiovascular death. A history of systemic hypertension or congestive heart failure were independent predictors of nonfatal acute MI, while a history of systemic hypertension, wall motion score index and diabetes mellitus independently predicted combined cardiovascular end-points. CONCLUSIONS: The results of this study confirmed that clinical risk indicators and LV systolic function were the most important independent predictors of cardiovascular death and combined cardiovascular end-points. LV diastolic function assessed by Doppler-echocardiography did not provide additional prognostic information.