Chronic volume overload is associated with left ventricular hypertrophy and high cardiovascular mortality in patients undergoing dialysis. Therefore, estimating body fluid status is important in these patients. However, most dry-weight assessments are still performed clinically, while attempts have been made to measure the volume status and dry weight of patients undergoing dialysis using bioimpedance analysis (BIA). BIA uses the electrical properties of the human body to alternate current flow and measures resistance values to estimate body water content and composition. BIA is divided into single-frequency BIA, multi-frequency BIA, and bioimpedance spectroscopy (BIS) according to the number of frequencies used, and into whole-body and segmental BIA according to whether or not the whole body is divided into segments. Extracellular water (ECW), intracellular water, and total body water (TBW) contents can be measured with BIA. Dry weight can be estimated by measuring the volume overload of the patient through the ECW/TBW and ECW-to-body weight ratios. Other estimation methods include the normovolemia/hypervolemia slope method, a resistance-reactance (RXc) graph, overhydration measurements using a body composition monitor, and calf BIS. In this review, we will examine the principles of BIA, introduce various volume status measurement methods, and identify the optimal method for patients undergoing dialysis.
Body Composition ; Body Fluids ; Body Water ; Dialysis* ; Human Body ; Humans ; Hypertrophy, Left Ventricular ; Methods ; Mortality ; Spectrum Analysis ; Water

INTRODUCTIONWe assessed the local prevalence, characteristics and 10-year outcomes in a heart failure (HF) cohort from the emergency room (ER).

MATERIALS AND METHODSPatients presenting with acute dyspnoea to ER were prospectively enrolled from December 2003 to December 2004. HF was diagnosed by physicians' adjudication based on clinical assessment and echocardiogram within 12 hours, blinded to N-terminal-pro brain natriuretic peptide (NT-proBNP) results. They were stratified into heart failure with preserved (HFPEF) and reduced ejection fraction (HFREF) by left ventricular ejection fraction (LVEF).

RESULTSAt different cutoffs of LVEF of ≥50%, ≥45%, ≥40%, and >50% plus excluding LVEF 40% to 50%, HFPEF prevalence ranged from 38% to 51%. Using LVEF ≥50% as the final cutoff point, at baseline, HFPEF (n = 35), compared to HFREF (n = 55), had lower admission NT- proBNP (1502 vs 5953 pg/mL, P <0.001), heart rate (86 ± 22 vs 98 ± 22 bpm, P = 0.014), and diastolic blood pressure (DBP) (75 ± 14 vs 84 ± 20 mmHg, P = 0.024). On echocardiogram, compared to HFREF, HFPEF had more LV concentric remodelling (20% vs 2%, P = 0.003), less eccentric hypertrophy (11% vs 53%, P <0.001) and less mitral regurgitation from functional mitral regurgitation (60% vs 95%, P = 0.027). At 10 years, compared to HFREF, HFPEF had similar primary endpoints of a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, and rehospitalisation for congestive heart failure (CHF) (HR 0.886; 95% CI, 0.561 to 1.399; P = 0.605), all-cause mortality (HR 0.663; 95% CI, 0.400 to 1.100; P = 0.112), but lower cardiovascular mortality (HR 0.307; 95% CI, 0.111 to 0.850; P = 0.023).

CONCLUSIONIn the long term, HFPEF had higher non-cardiovascular mortality, but lower cardiovascular mortality compared to HFREF.

Aged ; Aged, 80 and over ; Cardiovascular Diseases ; mortality ; Dyspnea ; diagnosis ; physiopathology ; Echocardiography ; Emergency Service, Hospital ; Female ; Heart Failure ; blood ; diagnostic imaging ; epidemiology ; physiopathology ; Humans ; Hypertrophy, Left Ventricular ; Male ; Middle Aged ; Mitral Valve Insufficiency ; epidemiology ; Myocardial Infarction ; epidemiology ; Natriuretic Peptide, Brain ; blood ; Peptide Fragments ; blood ; Prevalence ; Prospective Studies ; Singapore ; epidemiology ; Stroke ; epidemiology ; Stroke Volume ; Tertiary Care Centers ; Ventricular Remodeling

BACKGROUND AND OBJECTIVES: Left ventricular hypertrophy (LVH), a sign of subclinical cardiovascular disease, is an important predictor of cardiovascular morbidity and mortality. The aim of our study was to determine the association of left ventricular mass (LVM) with possible causative anthropometric and biochemical parameters as well as carotid intima-media thickness (CIMT) and brachial flow-mediated dilation (FMD) as surrogates of atherosclerosis and endothelial dysfunction, respectively, in previously untreated hypertensive patients. SUBJECTS AND METHODS: Our study included 114 consecutive previously untreated hypertensive patients who underwent echocardiography and ultrasonography to evaluate their vascular status and function via brachial artery CIMT and FMD. RESULTS: Among all study parameters, age, systolic blood pressure (BP), diastolic BP, pulse pressure, plasma glucose, uric acid, total bilirubin, direct bilirubin, hemoglobin, and CIMT were positively correlated with the LVM index. Multiple logistic regression analysis revealed that office systolic BP, age, male gender, and total bilirubin were independent predictors of LVH. CONCLUSION: Bilirubin seems to be related to LVM and LVH. The positive association of bilirubin with these parameters is novel and requires further research.
Atherosclerosis ; Bilirubin* ; Blood Glucose ; Blood Pressure* ; Brachial Artery ; Cardiovascular Diseases ; Carotid Intima-Media Thickness ; Echocardiography ; Humans ; Hypertension ; Hypertrophy, Left Ventricular* ; Logistic Models ; Male ; Mortality ; Ultrasonography ; Uric Acid ; Waist Circumference

BACKGROUND: Left ventricular (LV) hypertrophy caused by aortic valve stenosis (AS) leads to cardiovascular morbidity and mortality. We sought to determine whether aortic valve replacement (AVR) decreases LV mass and improves LV function. MATERIALS AND METHODS: Retrospective review for 358 consecutive patients, who underwent aortic valve replacement for degenerative AS between January 1995 and December 2008, was performed. There were 230 men and 128 women, and their age at operation was 63.2+/-10 years (30~85 years). RESULTS: There was no in-hospital mortality, and mean follow-up duration after discharge was 48.9 months (2~167 months). Immediate postoperative echocardiography revealed that LV mass index and mean gradient across the aortic valve decreased significantly (p<0.001), and LV mass continued to decrease during the follow-up period (p<0.001). LV ejection fraction (EF) temporarily decreased postoperatively (p<0.001), but LV function recovered immediately and continued to improve with a significant difference between preoperative and postoperative EF (p<0.001). There were 15 late deaths during the follow-up period, and overall survival at 5 and 10 years were 94% and 90%, respectively. On multivariable analysis, age at operation (p=0.008), concomitant coronary bypass surgery (p<0.003), lower preoperative LVEF (<40%) (p=0.0018), and higher EUROScore (>7) (p=0.045) were risk factors for late death. CONCLUSION: After AVR for degenerative AS, reduction of left ventricular mass and improvement of left ventricular function continue late after operation.
Aortic Valve ; Aortic Valve Stenosis ; Echocardiography ; Female ; Follow-Up Studies ; Heart Ventricles ; Hospital Mortality ; Humans ; Hypertrophy ; Hypertrophy, Left Ventricular ; Male ; Retrospective Studies ; Risk Factors ; Ventricular Function, Left

BACKGROUND: Left ventricular hypertrophy (LVH) is closely related with a high death rate, rhythmia, ischemic heart disease, stroke and sudden death. It is known that the prognosis becomes better as LVH regresses. Therefore, it is important to diagnose it correctly with ease in primary care. The authors evaluated the most standard cardio-thoracic ratio (CTR) with respect to LVH oriented towards elderly people whose body habitus changed over time as they had become older, and evaluated the factors which affect the rate of diagnosis including sensitivity and specificity. METHODS: A total of 231 subjects over 60 years of age who visited a general hospital health promotion center from March 1997 to August 2003, underwent echocardiography and identified not to have heart disease were selected. LV (left vetricular) mass was measured through echocardiography. LV mass was divided by 2.7 times of height (m) by Deveruex's method, and 49.1 g/m2.7 for men and 46.7 g/m2.7 for women were set to be standards of LVH. CTR was obtained by dividing the maximum transverse diameter of the heart by maximum transverse diameter of thorax on chest PA. RESULTS: CTR was observed on the basis of 0.45, 0.5, 0.55, and the agreement was highest of 0.5 for men and 0.45 for women. However, considering the sensitivity, the specificity, and the positive predictive value, it was thought to be most proper to be set at 0.5 was be standard for both men and women. When diagnosing LVH through chest PA, if 0.5 was set to be standard, false positive become high in women, false negative became high as height increased, and false negative became high as body mass index (BMI) increased. The smoking group showed higher false negative compared to the non- smoking group, and the false negative was higher as the level of hemoglobin increased. CONCLUSION: When diagnosing LVH through CTR in elderly people, it was appropriate to set 0.5 as a standard, but it is necessary to consider sex, body habitus, BMI, smoking and the level of hemoglobin.
Aged* ; Body Mass Index ; Death, Sudden ; Diagnosis ; Echocardiography ; Female ; Health Promotion ; Heart ; Heart Diseases ; Hospitals, General ; Humans ; Hypertrophy, Left Ventricular* ; Male ; Mortality ; Myocardial Ischemia ; Primary Health Care ; Prognosis ; Sensitivity and Specificity ; Smoke ; Smoking ; Stroke ; Thorax

BACKGROUND: Left ventricular hypertrophy (LVH) has been shown to be an independent risk factor for cardiovascular morbidity and mortality. The combination of hypertension and obesity are well known to act as risk factors of left ventricular hypertrophy in a number of studies, but it is unclear whether obesity itself stimulates LVH independently. Therefore, we investigated the relationship of left ventricular mass to body size in normotensive adults. METHODS: A population sample of 240 normotensive (systolic BP < 140 mmHg and diastolic BP < 90 mmHg) adults (139 men and 101 women) was examined by echocardiography. We excluded adults with history of hypertension, thyroid diseases, diabetes mellitus and other cardiac diseases. Left ventricular mass normalized for height(2.7) was used in the analyses and left ventricular hypertrophy was defined as a value of 50 g/m(2.7) men or 47 g/m(2.7) in women. RESULTS: Left ventricular mass significantly and positively correlated with body mass index. On univariate correlation analysis after adjusting for age, the body mass index was associated with LV mass/height(2.7) (LVMI: Left Ventricular Mass Index) in males and body mass index, waist circumference, hip circumference and waist/hip circumference ratio were associated with LVMI in females. Left ventricular hypertrophy was more frequent in overweight (33.3%) and obese (39.4%) groups than in lean group (15.9%). CONCLUSION: Left ventricular mass was strongly related to obesity in normotensive adults, especially in females. Obesity may be an independent risk factor for left ventricular hypertrophy.
Adult* ; Body Mass Index ; Body Size ; Diabetes Mellitus ; Echocardiography ; Female ; Heart Diseases ; Hip ; Humans ; Hypertension ; Hypertrophy, Left Ventricular ; Male ; Mortality ; Obesity* ; Overweight ; Risk Factors ; Thyroid Diseases ; Waist Circumference

BACKGROUND: Left ventricular hypertrophy (LVH) has been shown to be an independent risk factor for cardiovascular morbidity and mortality. The combination of hypertension and obesity are well known to act as risk factors of left ventricular hypertrophy in a number of studies, but it is unclear whether obesity itself stimulates LVH independently. Therefore, we investigated the relationship of left ventricular mass to body size in normotensive adults. METHODS: A population sample of 240 normotensive (systolic BP < 140 mmHg and diastolic BP < 90 mmHg) adults (139 men and 101 women) was examined by echocardiography. We excluded adults with history of hypertension, thyroid diseases, diabetes mellitus and other cardiac diseases. Left ventricular mass normalized for height(2.7) was used in the analyses and left ventricular hypertrophy was defined as a value of 50 g/m(2.7) men or 47 g/m(2.7) in women. RESULTS: Left ventricular mass significantly and positively correlated with body mass index. On univariate correlation analysis after adjusting for age, the body mass index was associated with LV mass/height(2.7) (LVMI: Left Ventricular Mass Index) in males and body mass index, waist circumference, hip circumference and waist/hip circumference ratio were associated with LVMI in females. Left ventricular hypertrophy was more frequent in overweight (33.3%) and obese (39.4%) groups than in lean group (15.9%). CONCLUSION: Left ventricular mass was strongly related to obesity in normotensive adults, especially in females. Obesity may be an independent risk factor for left ventricular hypertrophy.
Adult* ; Body Mass Index ; Body Size ; Diabetes Mellitus ; Echocardiography ; Female ; Heart Diseases ; Hip ; Humans ; Hypertension ; Hypertrophy, Left Ventricular ; Male ; Mortality ; Obesity* ; Overweight ; Risk Factors ; Thyroid Diseases ; Waist Circumference

BACKGROUND: Cardiovascular disease is the leading cause of morbidity and mortality in kidney transplantion recipients. Enhanced cardiac load by the persistence of functioning AVF in posttransplant period is associated with LV hypertrophy and may adversely influence cardiac outcome. METHODS: To investigate the impact of AVF on LV mass and function in kidney transplant recipients, 46 patients with functioning AVF were randomly assigned to surgical closure of AVF (fistular closing group, FC, n=23) or maintenance of fistula (fistular maintenance group, FM, n=23). Serum creatinine of all participants was stable(1.4+/-0.3). Mean age was 46+/-11. Mean posttransplant month was 78+/-53 (12-161). Echocardiography and determination of N-terminal pro-BNP, cTnT and CRP were done at 0, 1 and 6 months in group 1 (FC), and at 0 and 6 months in group 2 (FM). RESULTS: Baseline echocardiographic indices of systolic and diastolic LV function such as EF, E/A, E/E' and Tei index were not significantly different between groups. In patients whose AVF was surgically closed, LV mass (247.7+/-76.8 to 235.2+/-66.5, p=0.015) and LV mass index (144.0+/-10.1 to 137.1+/-8.6, p=0.02) significantly reduced at one month after closure, and no further significant change was observed at 6 months. In two groups no significant change in LV systolic and diastolic performance indices were observed. BNP, cTnT and CRP did not differ between groups in baseline value and did not change after closure. CONCLUSION: We conclude that the persistence of functioning AVF in kidney transplantation recipients is associated with LVH, and which can be reduced by closure of fistula. As LVH is one of major determinants of cardiovascular outcome in transplant patients as well as in general population, it would be prudent to close the fistula in patients with stable graft function.
Arteriovenous Fistula* ; Cardiovascular Diseases ; Creatinine ; Echocardiography ; Fistula ; Humans ; Hypertrophy ; Hypertrophy, Left Ventricular ; Kidney Transplantation* ; Kidney* ; Mortality ; Transplantation ; Transplants

PURPOSE: The leading cause of death of end-stage renal failure is cardiovascular disease. Elevated cardiac troponin T (cTnT) is associated with the high incidence and prevalence of cardiovascular disease and increased mortality and morbidity. Therefore the aim of this study was to examine the distribution of cTnT in continuous hemodialysis patients and clinical significance of elevated cTnT. METHODS: We studied 183 asymptomatic patients who were undergoing chronic continuous hemodialysis treatment. Predialysis blood samples also used to measure hematocrit, albumin, total cholesterol. We evaluated the history of coronary artery disease and the etiologies of renal disease using chart reviews and patients interviews and cardiac status were determined by electrocardiography, two-dimensional echocardiography and coronary angiography. Predialysis cTnT was measured by a second-generation assay, Elecsys 1010 and we considered patients with serum cTnT>0.1 ng/mL as positive. RESULTS: Forty two patients (23%) had cTnT greater than 0.1 ng/mL. Ischemic heart disease was observed in 18.6% (34/183), diabetes mellitus (DM) in 53.6% (98/183), hypertension in 92.3% (169/183) and left ventricular hypertrophy in 67.2% (123/183). cTnT revealed significantly higher level in the patients with age over 60, male, DM, pulse rate over 60 mmHg, ischemic heart disease (IHD), hematocrit under 36% and albumin under 3.7 g/dL. cTnT levels significantly correlated to ischemic heart disease, DM and male. CONCLUSION: In hemodialysis patients, cTnT level is related to age, sex, DM, pulse rate, IHD, hematocrit and albumin. A prospective study is necessary to provide information on the effect of correcting the controllable factors on cTnT level and cardiovascular mortality in maintenance hemodialysis patients.
Cardiovascular Diseases ; Cause of Death ; Cholesterol ; Coronary Angiography ; Coronary Artery Disease ; Diabetes Mellitus ; Echocardiography ; Electrocardiography ; Heart Rate ; Hematocrit ; Humans ; Hypertension ; Hypertrophy, Left Ventricular ; Incidence ; Kidney Failure, Chronic ; Male ; Mortality ; Myocardial Ischemia ; Prevalence ; Renal Dialysis* ; Troponin T* ; Troponin*

BACKGROUND: Chronic systemic inflammation in ESRD patients due to uremia and hemodialysis procedure itself comes into notice as a main factor for premature mortality secondary to rapid progressing atherosclerosis. Various pro-inflammatory cytokine, known to mediate these reaction of malnutrition, inflammation and atherosclerosis, are regulated by anti-inflammatory cytokine, such as IL-10. Quantitative production of IL-10 shows interindividual variability determined genetically by polymorphisms of promotor gene. The aim of this study was to measure the degree of IL-10 synthesis in ESRD patients treated with hemodialysis and evaluate the association with genotypes and cardiovascular risk factors. METHODS: The IL-10 genotypes for polymorphic bases at position at -1082 was determined in 66 chronic hemodialysis patients and 98 healthy subjects using highly specific PCR and the lipopolysaccharide (LPS)-stimulated IL-10 (sIL-10) release from whole blood were measured by ELISA. RESULTS: The distribution of the IL-10 genotypes in hemodialysis patients were similar to the general population, but the proportion of A allele in hemodialysis group was significantly higher (72.3% vs 59.8%, p=0.05). sIL-10 concentration were lower in hemodialysis patients compared with normal control (21.1 pg/mg vs 36.1 pg/mg, p=0.001) and both groups showed same relationship of sIL-10 with genotypes, that AA type was low producer. In multiple regression analysis, sIL-10 of normal group correlated negatively with age, creatinine, uric acid and existence LVH, and positively with albumin, hemoglobin. On the other hand, lower albumin, lower ejection fraction on echocardiography and existence of left ventricular hypertrophy were associated with higher sIL-10 in hemodialysis group. CONCLUSION: Polymorphisms by IL-10 genotypes were associated with production of IL-10 by endotoxin stimulation, and sIL-10 was lower in hemodialysis patients than in normal control. According to relation of sIL-10 with cardiovascular risk factors such as existence LVH, ejection fraction and malnutrition, it could be suggested that sIL-10 is useful marker in evaluating the risk of cardiovascular events.
Alleles ; Atherosclerosis ; Cardiovascular Diseases ; Creatinine ; Echocardiography ; Enzyme-Linked Immunosorbent Assay ; Genotype* ; Hand ; Humans ; Hypertrophy, Left Ventricular ; Inflammation ; Interleukin-10* ; Kidney Failure, Chronic ; Malnutrition ; Mortality, Premature ; Polymerase Chain Reaction ; Renal Dialysis* ; Risk Factors* ; Uremia ; Uric Acid