Valvular calcification and left ventricular modifying in peritoneal dialysis patients.

BACKGROUND: Cardiac valve calcification (CVC) and left ventricular (LV) alterations are frequent complication in end-stage renal disease (ESRD). We determined the prevalence of CVC and LV hypertrophy (LVH) in ESRD patients before renal replacement therapy and 12 months after peritoneal dialysis (PD). METHODS: A prospective longitudinal of 50 incident PD patients was studied. Demographic and clinical data were recorded and blood assayed at baseline and after 1-year of follow-up. CVC and LVH were evaluated by M-mode two-dimensional echocardiography. RESULTS: CVC of the mitral and aortic valves and of both valves were noted in 30, 18 and 10% of patients, respectively. After 12 months of PD regimen, 20% patients had aortic, 24% mitral and 8% had calcification of both valves. After one year of PD, LVH was 62 and 36% in patients with and without CVC, respectively (p < 0.05). Endothelin-1 is an independent predictor of CVC at the baseline, while nitric oxide is inversely an independent predictor at the end of follow-up. CONCLUSIONS: CVC is associated with LVH in PD patients. These findings identified a potential role for monitored markers to be incorporated into therapeutic strategies aimed at detection and treatment of cardiovascular complications and prevention strategies.

Valvular calcification and left ventricular modifying in peritoneal dialysis patients.

BACKGROUND: Cardiac valve calcification (CVC) and left ventricular (LV) alterations are frequent complication in end-stage renal disease (ESRD). We determined the prevalence of CVC and LV hypertrophy (LVH) in ESRD patients before renal replacement therapy and 12 months after peritoneal dialysis (PD). METHODS: A prospective longitudinal of 50 incident PD patients was studied. Demographic and clinical data were recorded and blood assayed at baseline and after 1-year of follow-up. CVC and LVH were evaluated by M-mode two-dimensional echocardiography. RESULTS: CVC of the mitral and aortic valves and of both valves were noted in 30, 18 and 10% of patients, respectively. After 12 months of PD regimen, 20% patients had aortic, 24% mitral and 8% had calcification of both valves. After one year of PD, LVH was 62 and 36% in patients with and without CVC, respectively (p < 0.05). Endothelin-1 is an independent predictor of CVC at the baseline, while nitric oxide is inversely an independent predictor at the end of follow-up. CONCLUSIONS: CVC is associated with LVH in PD patients. These findings identified a potential role for monitored markers to be incorporated into therapeutic strategies aimed at detection and treatment of cardiovascular complications and prevention strategies.

Thrombosed femoral artery pseudoaneurysm: complication of cardiac catheterization.

We present a case of catheter induced pseudoaneurysm of femoral artery and postprocedural course. This type of complications occurs in 2% to 8% patients after interventional procedures via trans femoral access and and has overall trend of increase due to significant number of this procedures in diagnostic and interventional cardiology. A 74-year-old female was admitted to Vascular department complaining of severe pain in her left groin. On physical examination, there was a femoral mass palpable but non-pulsatile in her left groin. Color Doppler documented the presence of femoral pseudoaneurysm as well as "to-and-fro" flow pattern on the pseudoaneurysm neck. CT arteriogram showed pseudoaneurysm with mostly thrombosed cavity, diameter of 85 x 27 mm. We concluded for further surgical repair.

[Arterial hypertension as a risk factor for multifocal atherosclerosis]. / Arterijska hipertenzija kao riziko-faktor za multifokalnu aterosklerotsku bolest.

BACKGROUND: It is well known that atherosclerosis as systemic disease have a significant correlation with score of multiple risk factors (MRF). Atherosclerosis as a multifocal disease, produces multisegmental stenotic changes of various arterial segments which arises simultaneously as a pre-existing asymptomatic disease. Aim of this study is to evaluate the presence of multifocal atherosclerotic disease among pts. with predominant arterial occlusive disease (AOD), and to correlate arterial hypertension as a major independent risk factor and multifocal atherosclerotic disease. METHODS: We included 109 consecutive patients treated at our Institute in the period Dec 1999--Dec 2000, all with clear arterial occlusive disease (AOD). According to Fontaine clinical staging of their AOD, we made three groups--group FII, clinical stage Fontaine II 63 pts, group FIII, clinical stage Fontaine III 32 pts, and group FIV, clinical stage Fontaine IV 14 pts. We evaluated clinical variables: age, gender, arterial hypertension (HTA), tobacco, hyperlipidemia (HLP), obesity (BMI), diabetes mellitus, coronary heart disease (CHD), and cerebrovascular disease (CVD). Score of MRF is calculated as x/9. Special focus has been made to pts. with positive HTA. All pts. were evaluated according to clinical evidence of CHD and CVD, respectively. RESULTS: We had 109 pts, 89 males and 20 females, average age of 62 yrs, males 63 and females 60 yrs. In the FII group were 63 pts. with average MRF 4.27, in the FIII group 32 pts. with MRF 3.97, in the FIV group 14 pts. with MRF 3.93. Out of the total number of pts. 52 were hypertensive (47.7%), 41 males, and 11 females, with average age 64.8 yrs, males, and 61.8 yrs, females. Isolated systolic HTA had 33 pts. (63.5%), and 19 pts. (36.5%) systolic and diastolic HTA. In whole group (n-109), multifocal disease, AOD + CHD, had 22 (20.21%) pts. (MRF score 4.86), AOD + CVD had (5.5%) 6 pts. (MRF score 3.66) and AOD + CHD + CVD had 8 (7.33%) patients (MRF score 6.13). In hypertensive pts. multifocal atherosclerotic disease, AOD + CHD, had 12 pts. (23.1%), and AOD + CHD + CVD, 2 pts (7.6%). Among clinical variables, tobacco was of high risk, 97 pts. positive (89.9%), what is of high significance, p < 0.001. CONCLUSIONS: We have a clear connection of multifocal disease with elevated MRF score, especially clinical variables, smoking (p < 0.001) and arterial hypertension (p < 0.01). Multifocal atherosclerotic disease was present in 36 pts. (33.1%), and among hypertensive pts. multifocal atherosclerotic disease was present in 14 pts. (26.9%). There is a high positive correlation rank of multifocal disease, HTA and score of MRF, r = .70, and borderline correlation rank of multifocal disease and score of MRF, r = .40.