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The reproducibility of cardiac magnetic resonance imaging measures of aortic stiffness and their relationship to cardiac structure in prevalent haemodialysis patients

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posted on 2019-08-29, 14:53 authored by MPM Graham-Brown, SF Adenwalla, FY Lai, WH Hunt, K Parke, G Gulsin, JO Burton, GP McCann
Background Aortic stiffness is one of the earliest signs of cardiovascular disease (CVD) in patients with chronic kidney disease and an independent predictor of mortality. It is thought to drive left ventricular (LV) remodelling, an established biomarker for mortality. The relationship between direct and indirect measures of aortic stiffness and LV remodelling is not defined in dialysis patients, nor are the reproducibility of methods used to assess aortic stiffness using cardiac magnetic resonance (CMR) imaging. Methods Using 3T CMR, we report the results of (i) the interstudy, interobserver and intra-observer reproducibility of ascending aortic distensibility (AAD), descending aortic distensibility (DAD) and aortic pulse wave velocity (aPWV) in 10 haemodialysis (HD) patients and (ii) the relationship between AAD, DAD and aPWV and LV mass index (LVMi) and LV remodelling in 70 HD patients. Results Inter- and intra-observer variability of AAD, DAD and aPWV were excellent [intraclass correlation (ICC) > 0.9 for all]. Interstudy reproducibility of AAD was excellent {ICC 0.94 [95% confidence interval (CI) 0.78–0.99]}, but poor for DAD and aPWV [ICC 0.51 (−0.13–0.85) and 0.51 (−0.31–0.89)]. AAD, DAD and aPWV associated with LVMi on univariate analysis (β = −0.244, P = 0.04; β =−0.315, P < 0.001 and β = 0.242, P = 0.04, respectively). Only systolic blood pressure, serum phosphate and a history of CVD remained independent determinants of LVMi on multivariable linear regression. Conclusions AAD is the most reproducible CMR-derived measure of aortic stiffness in HD patients. CMR-derived measures of aortic stiffness were not independent determinants of LVMi in HD patients. Whether one should target blood pressure over aortic stiffness to mitigate cardiovascular risk still needs determination.

Funding

This study is part of the research portfolio supported by the NIHR Leicester Biomedical Research Centre and the Leicester Clinical Research Facility based at the University Hospitals of Leicester and the University of Leicester. This study is independent research arising from a Clinician Scientist Award (to J.B., CS2013-13-014) supported by the NIHR.

History

Citation

Clinical Kidney Journal, 2018, 11(6), pp. 864–873.

Author affiliation

/Organisation/COLLEGE OF LIFE SCIENCES/School of Medicine/Department of Cardiovascular Sciences

Version

  • VoR (Version of Record)

Published in

Clinical Kidney Journal

Publisher

Oxford University Press (OUP) for European Renal Association - European Dialysis and Transplant Association (ERA-EDTA)

issn

2048-8505

eissn

2048-8513

Acceptance date

2018-04-27

Copyright date

2018

Available date

2019-08-29

Publisher version

https://academic.oup.com/ckj/article/11/6/864/5042178

Notes

Supplementary data are available at ckj online https://academic.oup.com/ckj/article-lookup/doi/10.1093/ckj/sfy042#supplementary-data

Language

en

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