Calcium infusion and left ventricular diastolic function in patients with chronic renal failure |
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Authors: | Virtanen V; Saha H; Groundstroem K; Seppala E; Pasternack A |
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Institution: | Departments of Medicine and Clinical Chemistry, Tampere University Hospital, FIN-33521 Tampere, Finland; University of Tampere Medical School, Tampere, Finland; Corresponding author |
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Abstract: | Background. Left ventricular (LV) function is
sensitive to disorders in calcium metabolism. Most previous reports have
focused on the effects of calcium on systolic performance. We studied the
acute effect of calcium infusion on LF diastolic function in patients with
moderate to severe chronic renal failure (CRF) and secondary
hyperparathyroidism (SHP). Methods. We infused calcium
gluconate at a constant rate of 45 &mgr;mol/kg/h to 14 patients with
severe to moderate CRF and SHP. Our aim was to reach slightly supranormal
levels of serum ionized calcium (1.35-1.45 mmol/l). LV diastolic function
was assessed by pulsed Doppler echocardiography before and after the
calcium infusion. The echocardiographic indices were compared to those of
14 age- and sex-matched healthy controls. Results.
Before calcium infusion the patients had significantly greater
LV dimensions than the controls, but there was no differences in the
diastolic indices. During calcium infusion, serum ionized calcium increased
from 1.18±0.03 to 1.40±0.03 mmol/l
(P<0.0001) and plasma intact PTH decreased from
38.6±5.6 to 9.0±2.2 pmol/l
(P<0.0001). Calcium infusion did not affect the
LV dimensions or fractional shortening. The peak early diastolic velocity
(Emax) decreased and peak late diastolic velocity (Amax) increased, and
their relationship decreased significantly (1.552±0.586 vs
1.414±0.535 m/s, P=0.03). These changes
reflect impairment of LV diastolic function. Conclusions.
Induction of acute hypercalcaemia by calcium infusion impairs LV
diastolic function in patients with CRF and SHP. |
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