|Amann K, Ritz E|
The Heart in Renal Failure: Morphological Changes of the Myocardium - New Insights
Journal of Clinical and Basic Cardiology 2001; 4 (2): 109-113
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Keywords: Herz, linksventrikuläre Hypertrophie, Mikrozirkulation, myokardiale Fibrose, Niereninsuffizienz, heart, left ventricular hypertrophy, microcirculation, myocardial fibrosis, renal failure
In patients with renal failure cardiovascular complications are an important clinical problem and cardiac death is the main cause of death in these patients. It is well documented that cardiac risk is increased by a factor of 20 in uraemic patients compared with age and sex matched segments of the general population. It has been known for a long time that atherosclerosis, particularly plaques in the epicardiac coronary conduit arteries, are more frequent in patients with chronic renal failure. Recently, clinical investigations showed, however, that myocardial infarction is responsible for only 30?50 % of all cardiac death. In contrast, 30?40 % of patients with renal failure and ischaemic heart disease, ie, angina pectoris, show patent coronary arteries on coronary angiogram. Thus, it is very likely that in uraemic patients myocardial ischaemia tolerance is markedly reduced even in the absence of classical atherosclerosis, ie, relevant stenosis of coronary arteries. This finding in patients with renal failure can be at least partially explained by well-described structural and metabolic abnormalities of the myocardium. The present paper focuses on structural changes of the heart and the vasculature and their potential repercussions for cardiovascular function and in particular their contribution to the high cardiovascular morbidity and mortality in patients with renal failure.