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

Alexander P Patrianakos ¹, Dimitrios Karakitsos ¹, Eric de Groot ², Frangiskos I. Parthenakis ¹, Evgenios Daphnis ¹ and Panos E. Vardas ^1*

¹ Heraklion University Hospital, Greece
² Academic Medical Centre, Netherlands

^* To whom correspondence should be addressed. E-mail: cardio{at}med.uoc.gr.

Accepted 30 March 2005

Abstract

Objective: Altered biophysical properties of the aorta are a major risk factor for increased cardiac morbidity and mortality in patients with end-stage renal disease (ESRD).

Aim: We present a novel, non-invasive echocardiographic application to assess the structural and functional properties of the complex composition of the proximal aorta.

Methods: Seventy-one haemodialysis patients [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 2D-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 ascending aorta. Pulse pressure (PP), pulse wave velocity (PWV), pressure strain elastic modulus (PSEM), characteristic impedance (Zcs) and â-index were calculated.

Results: Patients showed increased PP [68.3(7.2) v 51.4(5) mm Hg, p<0.001], PWV [6.0(1.0) v 3.9(0.5) m/sec, p<0.001], Zcs [174(57) v 110(30)(m/sec •cm2), p<0.001)], PSEM [872(254) v 540(140) mm Hg, p<0.001] and â-index [8.9(3.4) v 5.5(1.4),p<0.001] compared to 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 ESRD patients have impaired proximal aortic function compared to controls. Our 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.

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

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