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Rajan K. Patel, Patrick B. Mark, Gillian Macnaught, Kathryn K. Stevens, Emily P. McQuarrie, Tracey Steedman, Keith Gillis, Henry J. Dargie, Alan G. Jardine, Altered relative concentrations of high-energy phosphates in patients with uraemic cardiomyopathy measured by magnetic resonance spectroscopy, Nephrology Dialysis Transplantation, Volume 27, Issue 6, June 2012, Pages 2446–2451, https://doi.org/10.1093/ndt/gfr688
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Abstract
Premature sudden cardiovascular death is the commonest cause of death in end-stage renal disease (ESRD) patients and is associated with uraemic cardiomyopathy [left ventricular hypertrophy (LVH), systolic dysfunction (LVSD) or LV dilation]. High-energy phosphates (HEP), quantified using phosphorus-31 magnetic resonance spectroscopy, are reduced in patients with diabetes, heart failure and uraemia. Phosphocreatine:β adenosine triphosphate (PCr:ATP) ratio is an index of metabolic activity. We compared resting HEPs in ESRD patients and hypertensive patients (with and without LVH) who had normal renal function (LVH-only or normal myocardia). We also assessed associations of HEP levels with abnormalities of uraemic cardiomyopathy.
Fifty-three ESRD and 30 hypertensive patients (18 with LVH, 12 with normal myocardia) underwent phosphorus magnetic resonance spectroscopy of their left ventricle. PCr:ATP ratios were calculated from 31 P-MR spectra obtained from long-axis views of the left ventricle.
There were no significant differences in age, LV mass, chamber sizes and ejection fraction between patient groups. PCr:ATP was significantly lower in ESRD patients compared to hypertensive patients, irrespective of the presence or absence of LVH (P = 0.01). In the ESRD group, PCr:ATP was significantly lower in patients with LVSD (P = 0.05) and LV dilation (P = 0.01). LVH was not associated with significant difference in PCr:ATP.
ESRD patients have lower HEP levels compared to hypertensive patients. Lower PCr:ATP ratio, indicating altered myocardial metabolic function in ESRD patients, is associated with features of uraemic cardiomyopathy.
- myocardium
- polymerase chain reaction
- hypertension
- diabetes mellitus
- cardiomyopathy
- adenosine triphosphate
- renal function
- kidney failure, chronic
- heart failure
- left ventricle
- left ventricular hypertrophy
- cause of death
- dilatation, pathologic
- magnetic resonance spectroscopy
- phosphates
- phosphocreatine
- uremia
- heart
- phosphorus
- systolic dysfunction
- ejection fraction
- left ventricular systolic dysfunction
- cardiovascular death
- long axis
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