Echocardiographic detection of cardiac involvement in chronic renal failure

ABSTRACT

Echocardiography was performed for 57 male uraemic patients with no apparent coronary artery disease, pericardial effusion, valvular heart disease or heart failure. 38 patients were on maintenance haemodialysis of varying duration [from 4 to 50 months], their ages ranged from 21 to 60 years. The remaining 19 patients have been on medical treatment. Their ages ranged from 20 to 60 years. 20 healthy subjects age and sex matched were studied as controls. Six patients [15.8%] of the study group had completely normal echocardiogram. Five patients [13.15%] on regular haemodialysis had pericardial effusion, whereas two patients [10.53%] of medical treatment group had pericardial effusion. 84% of haemodialysis patients had abnormal left ventricular function with one or more abnormal echocardiographic parameters. The significant abnormalities were symmetric septal hypertrophy [40 patients], reduction of myocardial contractility [26 patients], enlargement of left ventricular cavity [18 patients] and thickening of left ventricular posterior wall [12 patients]. Similar findings were present in 11 of the 18 undialyzed uraemic patients. Five of the 38 patients on regular hemodialysis [13.2%] showed the typical picture of congestive cardiomyopathy. Their clinical data were not different from other patients in this study. Moreover, calcified mitral valve was observed in three patients [7.9%] and dilated aorta in two patients [5.3%] of dialyzed group. Also, it was observed that patients who had been on dialysis for a longer period had less cardiac abnormalities, suggesting that chronic dialysis might reverse these changes. In conclusion, the cardiac involvement in chronic renal failure [CRF] is suggested to be due to a specific uraemic cardiomyopathy. As hemodilysis gradually reverse the haemodynamic changes to normal. Moreover, echocardiography was more sensitive than chest X-ray and ECG in detecting clinically unsuspected cardiac abnormalities and provides useful information in the overall evaluation of cardiac function in uraemic patients