- Oral presentation
- Open Access
Early stage chronic kidney disease: a paradigm for diffuse fibrosis and clinical progression
© Edwards et al.; licensee BioMed Central Ltd. 2014
- Published: 16 January 2014
- Chronic Kidney Disease
- Late Gadolinium Enhancement
- Stage Chronic Kidney Disease
- Left Ventricular Mass Index
- Aortic Distensibility
Early stage chronic kidney disease (CKD) is an under recognised, highly prevalent cardiovascular (CV) risk factor. Despite a clustering of conventional atherosclerotic risk factors, there is a disproportionate rate of sudden cardiac death, heart failure and stroke rather than myocardial infarction. It is hypothesised that non-atherosclerotic processes, including left ventricular (LV) hypertrophy and fibrosis account for most of the excess CV risk.
In total, 30 patients (mean age 57 +/- 8 years) with CKD stage 2-4 (mean GFR 58 ± 22 ml/min/1.73 m2) with no history of cardiovascular disease (mean BP 129 mmHg ± 13/70 mmHg ± 11) or diabetes were compared with age and gender matched controls. All subjects underwent cardiac MRI (1.5T Siemens Avanto) for assessment of LV volumes, myocardial deformation (SPAMM tagging) and aortic distensibility. Late gadolinium enhancement (LE) and T1-mapping using a modified look-locker inversion recovery sequence (MOLLI) before and 15 minutes post gadolinium (0.1 mmol/Kg) for myocardial extracellular volume (ECV) were performed. Global ECV was the average measure from basal and mid short axis slices excluding LGE indicative of infarcted myocardium.
CMR parameters of structure and function
CKD (n = 30)
Controls(n = 30)
LV mass index (g/m2)
LA volume index (ml/m2)
Peak longitudinal systolic strain (%)
Peak longitudinal systolic strain rate (s-1)
Early longitudinal diastolic strain rate (s-1)
Aortic distensibility (mmHg-1)
Diffuse LV fibrosis is increased in early CKD with associated reductions in aortic distensibility and abnormal regional systolic and diastolic function. An increase in ECV detected by T1 mapping might be a key intermediate phenotype and follow-up studies are required to determine if it is predictive of impaired LV systolic function, heart failure events and mortality in CKD.
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