The Role Of Ultrasound In Evaluation Of Cardiovascular System Damage In Patients With End Stage Renal Disease

Part I Cardiac valve calcification by echocardiography predicts coronary artery calcium scores in dialysis patientsObjective:To determine whether cardiac valve calcification by echocardiography predict coronary artery calcium scores (CACS) in hemodialysis patients.Methods:This was a cross-sectional study of 169 stage V hemodialysis patients. The presence of calcification of the cardiac valves was assessed by echocardiography. All patients underwent multislice spiral computed tomography for quantification of CACS. According to CACS beyond 10,100,400 they were divided into 3 risk ranks; According to cardiac valve calcification they were divided into 4 classes:no valve calcification, aortic valve, mitral valve calcification and both valve calcification, Logistic regression was used to calculate the odds ratios (ORs) of having a CACS greater than 10,100 and 400 in presence of valve calcification.Results:Eighty-eight of the study patients (52.0%) had echocardiographic evidence of valvular calcification. Patients with aortic valve calcification, mitral valve calcification and both valve calcification had a significantly greater likelihood of having CACS>400 (odds ratio [OR]=4.62; 95% confidence interval [95% CI] (1.22～17.4); P=0.02; odds ratio [OR]=5.35; 95% confidence interval [95% CI] (1.37～20.5); P=0.01; odds ratio [OR]=16.94; 95% confidence interval [95% CI] (5.16～55.6; P=0.0001).Conclusions:The cardiac valve calcification in hemodialysis patients was strongly associated with the presence and degree of CACS independently of clinical risk factors. Ec hocard io grap hy is a useful method to predict CACS in prevalent hemodialysis patients by detecting cardiac valve calcification.PART II Evaluation of plaque vulnerability using contrast-enhanced ultrasound in hemodialysis patients:a pilot studyBackground:Stroke incidence in hemodialysis patients is up to 10 times greater than in the general population. Vulnerable plaque is an important reason for the high incidence of cardiovascular and cerebro vascular diseases. Intraplaque neovascularization (IPN) and plaque ulceration are markers of the vulnerable plaque. Objective:The aim of this study was to assess the intraplaque neovascularization and plaque ulceration in hemodialysis patients using contrast-enhanced ultrasound.Methods:This was a cross-sectional study of 169 stage V hemodialysis patients. Using the standard ultrasound,83 plaques were detected in 66 patients with end stage renal disease. A total of 38 patients with ESRD and carotid atherosclerotic plaque underwent standard carotid ultrasound in conjunction with contrast-enhanced ultrasound (CEUS) to assess IPN and plaque ulceration.Results:CEUS revealed IPN in 86.7% of the patients, ulcerated surface in 5 patients (13.2%), with a median plaque thickness of 2.4 mm (inter-quartile range 1.9-3.1mm), a median of plaque areas of 0.23 mm2 (inter-quartile range 0.10-0.43 mm2). In these 38 patients (67 palques),12(17.9%) plaque size (areas and thickness) increased after infusion of contrast agents,1(1.5%) plaque was not detected using standard carotid ultrasound tools. Multivariable analysis identified the border of plaque, Low-density lipoprotein cholesterol, total cholesterol and duration of HD was independent, significant predictors for IPN.Conclusions:Patients with ESRD have a high prevalence of IPN. Our preliminary results suggest the border of plaque, Low-density lipoprotein cholesterol, total cholesterol and duration of HD correlated with IPN on CEUS. Further clinical studies are needed to clarify whether CEUS provides plaque vulnerability to this group of patients.