LEFT-VENTRICULAR MORPHOLOGY AND DIASTOLIC FUNCTION IN UREMIA - ECHOCARDIOGRAPHIC EVIDENCE OF A SPECIFIC CARDIOMYOPATHY

Objective-To see whether cardiac morphological and functional abnormal ities in uraemic patients are determined by high blood pressure or if they are an expression of a specific cardiomyopathy. Design-Cross sect ional study. Setting-City general hospital in Italy. Subjects-35 uraem ic patients receiving haemodialysis (17 men, 18 women; mean age 60.3 ( 11.2); mean duration of dialysis 52 months) were selected from the 64 patients in Venice who were receiving dialysis; subjects diabetes, hae mochromatosis, dysfunction, regional dyskinesias, and pericarditis wer e excluded. 19 control normotensive subjects (6 men and 13 women), mat ched for age. Main outcome measures-Echocardiographic measurements of left atrium, left ventricular end diastolic and end systolic volume, a ortic root diameter, posterior wall and interventricular septum thickn ess, left ventricle mass index, and ejection fraction in controls and in patients according to whether they were normotensive (five men, eig ht women) or hypertensive (12 men, 10 women) on 48 hour ambulatory mon itoring; left ventricular diastolic function by Doppler ultrasonograph y. Results-Mean systolic and diastolic pressures, daytime systolic and diastolic pressures, and night time systolic and diastolic pressures were significantly higher in the hypertensive patients than in the nor motensive patients. The normotensive patients had similar blood pressu res to the controls. Left ventricular mass correlated significantly wi th the mean diastolic pressure and mean night time systolic and diasto lic pressures. Parathyroid hormone concentrations were similar in the two groups of patients. Diastolic relaxation was impaired to the same degree in the two groups of patients. Parameters of diastolic function showed no relation to left ventricular mass, which was significantly higher in the hypertensive than in the normotensive patients. Conclusi ons-Uraemia is likely to induce specific changes in the relaxation pro perties of the myocardium. These changes are responsible for the impai red diastolic function independently of blood pressure, degree of hype rtrophy, and metabolic changes, which suggests the existence of a spec ific cardiomyopathy. Hypertension remains a determinant of left ventri cular mass.