5-8
A study of Myocardial dysfunction and its risk factors in patients of Chronic Kidney Disease(CKD)
Gupta KL MR Ram Anil Raj, , Behl Ajay , Ganguli Anirban

Introduction:
Left ventricular hypertrophy (LVH) is an important myocardial defect contributing to cardiovascular mortality in CKD but the prevalence of myocardial systolic and diastolic dysfunction and its risk factors in CKD are less known.

Methodology:
Sixty CKD patients (stage 3 to 5) without any prior cardiac disease underwent a single point echocardiographic assessment . Myocardial parameters assessed were LV mass index (LVMI), LV ejection fraction(LVEF) fractional shortening (FS) E:A ratio and E- wave deceleration time .

Results:
Overall prevalence of LVH was 85.0% ( 80.3% concentric LVH and 20% eccentric LVH) and did not differ significantly in different stages of CKD ( 81.8% in Stage 3, 84.2% in Stage 4 and 86.7% in Stage 5).Mean LVEF was 61.48 + 8.74%, mean FS= 32.95 + 7.10, mean LV E/A ratio = 1.077 + 0.300, E-wave deceleration time(EDT)= 199.08 + 61.40 ms, LV end diastolic volume(LVEDV)=95.97 + 32.09ml , LV end-systolic volume(LVESV)=36.97+ 17.10ml and LVMI=149.713 +54.960g/m2 Body surface area . LVMI, LVEDV and LVESV were significantly higher in stage 5 compared to stage 4 whereas no difference was seen between Stage 3 and stage 4. No significant difference was seen between the 3 stages in prevalence of diastolic dysfunction ( 72.7% Stage 3, 68.4% in Stage 4 and 73.7% in Stage 5, p=0.930) and systolic dysfunction(18.2 % in Stage 3, 10.5% in Stage4 and 3.3% in Stage %,p=.550). LVMI correlated significantly with GFR( Cockcroft Gault formula, r=-0.32,p< 0.05) even after correction of hemoglobin(Hb). The Ca X P product correlated significantly with LVMI ( r=0.313, p=0.015) and LVEF( r=-0.332,p=0.010) . LV E/A showed significant correlation with age only(r=-0.422,p=0.001) while E-wave deceleration time did not show any correlation with clinical , biochemical and hematological parameter.

Conclusion:
Diastolic dysfunction appeared to be common in all stages of CKD and exceeded systolic dysfunction in magnitude . The only risk factor for systolic dysfunction was the Ca X P product while no correlation was observed between hypertension ,Hb and diabetes mellitus (conventional risk factors for LVH in CKD) with diastolic dysfunction.

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