T AMIN1, N KARIM2, B COSTELLO3, M ROBERTS1, L MCMAHON1
1Eastern Health, Melbourne, Australia, 2Monash Health, Melbourne, Australia, 3Alfred Health, Melbourne, Australia
Background:Patients with chronic kidney disease (CKD) have a higher risk of cardiovascular morbidity and mortality compared to the healthy populous. The mechanisms are complex but involve cardiac fibrosis (CFib) and related dysfunction. Cardiac magnetic resonance imaging (cMRI) allows evaluation of both, and we explored CFib in patients with CKD compared to healthy volunteers (HV) with normal kidney function.
Methods: Cardiac function, morphology and tissue characterisation were compared between 10 patients with CKD Stages 3-5, 12 patients on maintenance haemodialysis (HD) and 26 HV. Cardiac function and native T1 mapping time (nT1mt), using saturation recovery single-shot acquisition (SASHA) and shortened modified look-locker inversion recovery (ShMOLLI) to measure CFib, were compared across groups using analysis of variance (ANOVA) and post-hoc comparison.
Results:Left ventricular (LV) ejection fraction was 62±5%, 62±8%, and 64±10% (p=0.692), and LV mass was 111±34g/m2, 136±32g/m2, and 137±34g/m2 (p=0.056) in HV, CKD and HD groups, respectively. The nT1mt (SASHA) were 1485±42ms, 1547±45ms and 1600±105ms (p<0.001), and (ShMOLLI) 1157±63ms, 1186±36ms and 1219±47ms (p<0.001), respectively. In post hoc comparisons, nT1mt were significantly lower in HV than CKD (p=0.034 for SASHA, p<0.01 for ShMOLLI) or HD (p<0.01 for both), but not different between CKD and HD (p=0.152 for SASHA, p=0.255 for ShMOLLI).
Conclusion:Despite similar LV ejection fraction and LV mass, cMRI detected increased CFib in patients with CKD and HD. Thus, CFib appears early in CKD and may help identify CKD patients at higher risk of adverse cardiac outcomes.
I have completed my fellowship in Nephrology 2012 and currently working at Eastern Health, Melbourne. Along with my clinical work, I have commenced part time PhD on cardiac arrhythmia in Chronic Kidney Disease (CKD) patients in 2016; where my main interest is to evaluate the role of intrinsic and extrinsic factors in cardiac arrhythmias and sudden cardiac death in patients with CKD requiring haemodialysis.