CARDIOVASCULAR MEDICINE

Alteration of proximal aorta biophysical properties in patients with end stage renal disease

A P Patrianakos¹, D N Karakitsos², E de Groot³, F I Parthenakis¹, E K Daphnis², P E Vardas¹

¹ Department of Cardiology, Heraklion University Hospital, Crete, Greece
² Department of Nephrology, Heraklion University Hospital, Crete, Greece
³ Department of Vascular Medicine, Academic Medical Centre, Amsterdam, the Netherlands

Correspondence to:
Professor Panos E Vardas
Cardiology Department, Heraklion University Hospital, PO Box 1352 Stavrakia, Heraklion, Crete, Greece; cardio{at}med.uoc.gr

Objective: To present a novel, non-invasive echocardiographic application to assess the structural and functional properties of the complex composition of the proximal aorta in patients with end stage renal disease (ESRD).

Methods: 71 haemodialysis patients (mean (SD) age 61.3 (9.3) years, dialysis duration 79.2 (51.6) months) and 62 age matched controls were studied. From the suprasternal view, the distance between ascending and descending aorta was measured with two dimensional ultrasound. The aortic flow wave transit time was measured with pulsed wave Doppler. M mode echocardiography, with simultaneous blood pressure estimates, was used to assess the diameters of the aortic annulus and of the ascending aorta. Pulse pressure, pulse wave velocity (PWV), pressure strain elastic modulus, characteristic impedance, and ß index were calculated.

Results: Patients had increased pulse pressure (68.0 (7.2) v 51.4 (5.0) mm Hg, p < 0.001), PWV (6.1 (1.1) v 3.9 (0.6) m/s, p < 0.001), characteristic impedance (174 (58) v 111 (31) m/s·cm², p < 0.001), pressure strain elastic modulus (872 (254) v 541 (140) mm Hg, p < 0.001), and ß index (8.9 (3.4) v 5.5 (1.4), p < 0.001) compared with controls. In patients PWV was correlated with age and time on haemodialysis (r = 0.44, p < 0.001, and r = 0.51, p < 0.001, respectively).

Conclusion: A novel application of duplex ultrasound of the proximal aorta showed that patients with ESRD have impaired proximal aortic function compared with controls. The data indicate that these non-invasive measurements can be used to describe status and change in aortic biophysical properties and may be used as a marker for cardiovascular disease risk.

Abbreviations: AO_D, aortic diastolic diameter; AO_S, aortic systolic diameter; CI, confidence interval; DBP, diastolic blood pressure; E_P, pressure strain elastic modulus; ESRD, end stage renal disease; MABP, mean arterial blood pressure; MRI, magnetic resonance imaging; PP, pulse pressure; PWV, pulse wave velocity; SBP, systolic blood pressure; Z_CS, characteristic impedance corrected for ascending aorta diameter

Keywords: aortic stiffness; end stage renal disease; pulse wave velocity; ultrasound

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