To survey the features of left ventricular morphological parameters and their relationship with some characteristics of patients with chronic kidney disease. Subjects and methods: Cross-sectional descriptive study was carried out on 78 predialysis patients at Nephrology and Hemodialysis Department, 103 Military Hospital. Patients received cardiac Doppler ultrasound to evaluate left ventricular structures.
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EVALUATION OF LEFT VENTRICULAR MORPHOLOGICAL PARAMETERS USING ECHOCARDIOGRAPHY IN PATIENTS
WITH CHRONIC KIDNEY DISEASE
Nguyen Dang Trong 1 ; Bui Cong Sy 1 ; Le Viet Thang 1
SUMMARY
Objectives: To survey the features of left ventricular morphological parameters and their relationship with some characteristics of patients with chronic kidney disease Subjects and methods: Cross-sectional descriptive study was carried out on 78 predialysis patients at Nephrology and Hemodialysis Department, 103 Military Hospital Patients received cardiac Doppler ultrasound to evaluate left ventricular structures Results: The average glomerular filtration rate was 28.47 mL/min The proportion of patients with left ventricular hypertrophy was 35.9%, there were 21.8% and 39.8% of patients with dilatation at end systo;ic and diastolic, 57.7% of patients with interventricular septal thickness at diastolic and 37.2% of patients with interventricular septal thickness at systolic Changes in left ventricular structures related to blood pressure, anemia, glomerular filtration rate and hypoalbumin, p < 0.05 Conclusion: The changes of left ventricular morphological were common in patients with chronic kidney disease
* Keywords: Chronic kidney disease; Left ventricular structures; Echocardiography.
INTRODUCTION
Chronic kidney disease (CKD) is
increasing in the world as well as in
Vietnam Cardiovascular events are the
main causes of death in this group of
patients Prolonged azotemia syndrome is
one of the causes of cardiovascular events
Hypertension is a common manifestation
of CKD Hypertension causes structural
and morphological changes in the heart,
particularly at the left ventricle very soon
Along with other disorders, changes in
left ventricular morphology become
more severe over time Evaluating left
ventricular morphological changes with echocardiography and determining their association with some characteristics of patients with chronic non-dialysis kidney disease is a study to do Therefore, we conducted this research with the goals:
- To investigate some left ventricular morphological indicators with cardiac Doppler ultrasound in patients with chronic renal disease without dialysis
- To understanding the relationship between some morphological indicators with characteristics of patients with chronic non-dialysis kidney disease
1 103 Military Hospital
Corresponding author: Nguyen Dang Trong (dangtrong1989@gmail.com)
Date received: 08/07/2019
Date accepted: 07/08/2019
Trang 2SUBJECTS AND METHODS
1 Subjects
78 patients with CKD, who were
treated at Nephrology and Hemodialysis
Department, 103 Military Hospital
Time study: From 9 - 2018 to 6 - 2019
* Criteria for patient selection:
- The patient was diagnosed with CKD
according to KDIGO 2012 standard and
had not been hemodialysis
- Including patients with primary and
secondary CKD
- Above 16 years old
- Patients with CKD who require dialysis
but waiting for kidney transplantation, so
there is no dialysis
- Agreed to participate in the research
* Criteria of exclusion:
- Patients refused to join in study
- Patients with heart valve disease,
myocardium before kidney disease
- Patients with acute diseases such as
myocardial infarction, myocarditis, acute
heart failure
2 Methods
Cross-sectional descriptive study,
sequence included:
- Detecting medical history and clinical
examination
- Laboratory tests: Calculating glomerular
filtration rate according to MDRD
- Echocardiography: TM, 2D, color Doppler according to the guidelines of the Vietnamese Cardiovascular Association, measuring parameters: Dd, Ds, EF% Apply calculation formula EDV, LVM, LVMi
+ End diastolic volume (EDV):
ED
+ End systolic volume (ESV):
+ Left ventricular mass was calculated
by Penn formula: LVM = 1.04 [(LVEDd + IVSd + LVPWd)3 - Dd3] - 13.6 g
+ Left ventricular mass index (LVMi): LVMi (g/m2) = LVM (g)/BSA (m2)
Left ventricular hypertrophy when LVMi
> 134 g/m2 (male) and LVMi > 110 g/m2 (female)
* Data processing:
Data are processed according to statistical algorithms applied in biomedical Using SPSS 22, EPI software - Info 7.0,
p < 0.05 was considered statistically significant
RESULTS
The study conducted on 78 patients with an average age of 53.47 years, male accounted for 62.8%, female accounted for 37.2% The average glomerular filtration rate was 21.53 mL/min
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1 Characteristics of left ventricular structures
Table 1: The characteristics of left ventricular structures measured in patients (n = 78)
Dd (mm)
Ds (mm)
IVSs (mm)
IVSd (mm)
LVPWs (mm)
LVPWd (mm)
The percentage of hypertrophy of posterior left ventricular wall at diastolic and systolic was 34.6% and 21.8%; the percentage of hypertrophy of interventricular septal thickness at diastolic and systolic was 57.7% and 37.2%
Table 2: The characteristics of left ventricular structures were calculated
LVM (g)
LVMI (g/m2)
Trang 4Normal 47 60.2
Vd (mL)
Vs (mL)
Percentage of left ventricular hypertrophy was 35.9%, the rate of left ventricular dilatation at the end of diastolic was 39.8%, the rate of left ventricular dilatation at the
end of systolic was 21.8%
2 The relationship between left ventricular morphology with characteristics
of patients
Table 3: The relationship with the stages of CKD (n = 78)
Stage 1 + 2 (n = 13)
Stage 3 + 4 (n = 21)
Stage 5
LVMI (g/m2) 78.48 ± 18.03 93.09 ± 19.37 122.24 ± 35.85 < 0.05
Vd (mL) 92.44 ± 23.31 108.56 ± 25.06 120.58 ± 35.53 < 0.05
There was an association between LVM, LVMi, Vd with stages of CKD (p < 0.05)
Table 4: The relationship with hypertension (n = 78)
Hypertension (n = 57)
Normal blood pressure
There was an association between LVM, LVMi with hypertension (p < 0.05)
Table 5: The relationship with anemia (n = 78)
Moderate and severe (n = 26)
Mild (n = 33)
Normal
LVM (g) 205.55 ± 57.68 162.12 ± 33.45 134.87 ± 41.13 < 0.05 LVMi (g/m2) 127.86 ± 37.43 104.08 ± 23.80 86.69 ± 32.39 < 0.05
Vd (mL) 123.97 ± 41.40 108.79 ± 21.26 103.87 ± 32.65 > 0.05
There was an association between LVM, LVMi with anemia (p < 0.05)
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Table 6: The relationship with hypoalbumin (n = 78)
There was an association between LVM, LVMi, Vd with hypoalbumin (p < 0.05)
Chart 1: Correlation between LVMI and hemoglobin (n = 78)
There was a negative correlation between LVMi and Hb, the correlation coefficient
r = -0.509, p < 0.001 Correlation equation: LVMi = -0,596 * Hb + 170.861
Chart 2: Correlation between LVMI with glomerular filtration rate (n = 78)
There was a negative correlation between LVMi and glomerular filtration rate, the correlation coefficient r = -0.497, p < 0.001 Correlation equation: LVM = -0,505* glomerular filtration rate + 122.162
r = -0,509
p < 0,001
Trang 6DISCUSSION
Our study had 78 patients, the average
age of the study group was 53.47 ± 19.06
years, with 29 female (37%) and 49 male
(63%), the average glomerular filtration
rate was 28.17 ± 32.77 mL/min
Left ventricular hypertrophy rate was
35.9% compared to the Jan Malik study;
the left ventricular hypertrophy rate in
CKD stage 1 - 3 was 20%, increased with
the degree of kidney damage [4] According
to the study by Do Doan Loi, the rate of
left ventricular hypertrophy was 29.3% in
patients who started hemodialysis [1]
According to Patrick S.P's study, the
proportion of patients with left ventricular
hypertrophy with normal systolic function
who started hemodialysis was 76% [2],
our results were randomized to reflect the
overall degree of hypertrophy of predialysis
patient According to Giovanni C, rate of
hypertrophy (34 - 78%) depending on the
study [3]
According to Middleton RJ's study, the
rate of left ventricular dilatation in patients
with CKD was 28% [4] According to
Gerard M London, the rate of left
ventricular dilatation was 32 - 38% of
patients [5] In our study, it was 39.8%, it
was higher than the results of Middleton's
study due to our research patients in
stage 5 mainly, they were indications of
hemodialysis
We divided patients into groups of
CKD stage 1 - 2, CKD stage 3 - 4 and
stage 5, we found a significant increase in
left ventricular mass index, diastolic left
ventricular volume in the groups (p < 0.05)
(table 3), and we found a correlation
between glomerular filtration rate and LVMi, negative correlation, moderate correlation
r = -0.497, p < 0.001 (chart 2), this shows
the effect of CKD on left ventricular structures, the more severe renal damage, the more changes in left structures, the most significant change when patients with stage 3 kidney disease with glomerular filtration rate below 60 mL/min [6]
When assessing the relationship between left ventricular hypertrophy and blood pressure status of study patients,
we found an association between LVM, LVMi and blood pressure, in patients with hypertension LVM and LVMi indexes increased significantly compared to patients
without hypertension (table 4)
We found an association between the structures index and the anemia of patients, patients were divided into groups: no anemia, mild anemia, moderate and severe anemia, we found the index LVM, LVMi increased significantly in the above groups (p < 0.05), and a negative correlation between LVMi and hemoglobin, moderate
correlation r = -0.509, p < 0.001 (chart 1)
Between the hypoalbumin and some left ventricular structures (LVM, LVMi, Vd)
(table 6), we found that the reduction of
serum albumin increased the diastolic left ventricular volume, left ventricular mass, and left ventricular mass index compared with patients without hypoalbumin (p < 0.05), decreased serum albumin was not directly related to left ventricular hypertrophy,
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but it was associated with other factors:
Hypertension, anemia, the progression
of CKD
CONCLUSION
When studying the left ventricular
morphological parameters using cardiac
Doppler ultrasound in patients with CKD,
we had some conclusions:
- The rate of left ventricular hypertrophy
was 42.4%; left ventricular dilatation at the
end of diastole was 39.8%; the percentage
of hypertrophy of posterior left ventricular
wall at diastolic and systolic was 34.6%
and 21.8%; the percentage of hypertrophy
of interventricular septal thickness at
diastolic and systolic was 57.7% and 37.2%
- Left ventricular hypertrophy was
associated with blood pressure, anemia,
glomerular filtration rate, serum albumin
reduction of patients with CKD
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