Cardiac mechanics in chronic kidney disease

Hensen, L.C.R. (2019)

Doctoral Thesis

Chronic kidney disease (CKD) is a worldwide growing epidemic associated with an increased risk of cardiovascular morbidity and mortality. Heart failure is particularly frequent among patients with CKD. Pressure and volume overload and non-hemodynamic factors associated with CKD induce left ventricular (LV) hypertrophy, reduce capillary density and increase myocardial fibrosis that lead to LV diastolic and systolic dysfunction. These processes have been proposed as important determinants of increased mortality in this population.
The aim of this thesis was to evaluate cardiac mechanics using two-dimensional (speckle tracking) echocardiography and coronary computed tomography angiography in patients with CKD to define the prevalence and prognostic implications of cardiovascular diseases.
In pre-dialysis and dialysis patients with preserved LV ejection fraction (LVEF), assessment of left ventricular global longitudinal strain (LV GLS) helps to identify patients with higher rates of heart failure hospitalization and all-cause mortality. When LVEF has already declined, patients within the lowest quartile of LV GLS showed worse prognosis compared to the other groups.
The burden of cardiovascular diseases in patients with CKD is high and thorough assessment of cardiac mechanics with (advanced) echocardiographic techniques and coronary CTA helps in identifying patients with worse prognosis, who would potentially benefit of early treatment.

• Echocardiography
• Strain
• Chronic kidney disease
• Valvular heart disease
• Atrial fibrillation
• Valve calcium
• LV systolic function
• LV mechanical dispersion

• All authors: Hensen, L.C.R.
• Supervisor: Jukema, J.W.; Bax, J.J.
• Co-supervisor: Rotmans, J.I.
• Committee: Schalij, M.J.; Reinders, M.E.J.; Voors, A.A.; Vriend, J.W.J.
• Qualification: Doctor (dr.)
• Awarding Institution: Leiden University of Medical Center [LUMC], Leiden University
• Date: 2019-05-15
• ISBN (print): 9789402814071