Is echocardiography mandatory for patients with chronic kidney disease?

This study aims at evaluating the prevalence of left ventricular diastolic dysfunction in a group of 319 hypertensive patients with stage 3b-4-5 chronic kidney disease (according to Kidney Disease Improving Global Outcomes classification), compared with 216 patients with essential hypertension and normal renal function. All patients underwent echocardiographic examination. Patients on stage 1-2-3a chronic kidney disease, dialysis treatment, or with previous manifestations of heart failure or other cardiovascular diseases were excluded. Patients with renal disease had significantly worse diastolic function (both considering trans-mitral flow and tissue Doppler imaging parameters). Diastolic dysfunction is found in 70.5% of the CKD group and in 41.6% of hypertensive patients (p < 0.0001). Multiple regression analysis shows an association between renal function and diastolic function (ß 0.223; p < 0.0001), independent of potential confounders. Our study shows that diastolic dysfunction is highly prevalent in patients with advanced chronic kidney disease; we posit that in this population, the risk of diastolic heart failure is very high. We think that patients with a marked decrease of glomerular filtration rate (GFR) must be considered at high risk for diastolic heart failure and should have an echocardiographic examination performed, even if asymptomatic and in the absence of evident cardiovascular disease.

Unusual presence of 'ghosts' following lead extraction for recurrent reactive pericarditis: a case report.

BACKGROUND: The presence of a persistent fibrous sheath in right-sided heart chambers after transvenous lead extraction has already been described in some studies as echocardiographic tubular mobile masses called 'ghosts'. Their presence has been associated with cardiac device-related infective endocarditis or local device infection, but to the best of our knowledge, this is the first case where 'ghosts' have been reported among non-infected patients. CASE SUMMARY: We present a case of a 73-year-old woman hospitalized due to worsening dyspnoea and a significant pericardial effusion, relapsed after pericardiocentesis with removal of about 1500 mL of non-haemorrhagic fluid. The patient's history revealed a previous dual-chamber pacemaker implantation due to symptomatic sick sinus syndrome. Transoesophageal echocardiography (TOE), essential to exclude endocarditis vegetations suggested an etiopathogenesis of mechanical irritation caused by the distal end of the passive fixation atrial lead on the right atrial appendage wall. Considering the echocardiographic report and the condition of reactive pericarditis with the early relapse of the significant pericardial effusion after pericardiocentesis, we opted for a lead removal procedure to eliminate the stimulus causing the irritation, with transoesophageal echocardiographic monitoring, thus the early detection of a 'ghost' was possible. DISCUSSION: This is the first clinical case describing the presence of fibrin 'ghosts' sometime after the implantation of a pacemaker, highlighting a non-exclusively infectious genesis, and emphasizing the importance of TOE for the early detection of this post-extraction complication and its monitoring.