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  • Review Article
  • Published:

Cardiac imaging in patients with chronic kidney disease

Nature Reviews Nephrology volume 11, pages 207–220 (2015)Cite this article

Subjects

Key Points

  • A number of available cardiac imaging tools provide information about cardiac structure and function in patients with renal disease

  • 2D echocardiography is simple and non-invasive, and is a useful first-line cardiac investigative tool

  • 2D echocardiography can identify structural changes associated with poor prognosis but can be prone to inaccuracy as some measurements are derived rather than actual dimensions

  • 3D echocardiography is comparable to the 'gold standard' investigative tool of cardiac MRI for estimating left ventricular mass and volumes

  • Cardiac PET and single-photon emission CT provide information on myocardial perfusion in renal patients

  • Different cardiac imaging modalities may be used in combination to provide a thorough assessment of the cardiac status of renal patients

Abstract

Patients with chronic kidney disease (CKD) carry a high cardiovascular risk. In this patient group, cardiac structure and function are frequently abnormal and 74% of patients with CKD stage 5 have left ventricular hypertrophy (LVH) at the initiation of renal replacement therapy. Cardiac changes, such as LVH and impaired left ventricular systolic function, have been associated with an unfavourable prognosis. Despite the prevalence of underlying cardiac abnormalities, symptoms may not manifest in many patients. Fortunately, a range of available and emerging cardiac imaging tools may assist with diagnosing and stratifying the risk and severity of heart disease in patients with CKD. Moreover, many of these techniques provide a better understanding of the pathophysiology of cardiac abnormalities in patients with renal disease. Knowledge of the currently available cardiac imaging modalities might help nephrologists to choose the most appropriate investigative tool based on individual patient circumstances. This Review describes established and emerging cardiac imaging modalities in this context, and compares their use in CKD patients with their use in the general population.

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Figure 1: Cross-sectional representation of the heart with different left ventricular geometries.
Figure 2: 2D transthoracic echocardiography image showing a cross section through the IVC over time and collapse of the IVC during a 'sniff test' in an individual with normal atrial filling pressure and no hypervolaemia.
Figure 3: Estimation of left ventricular geometry using 2D transthoracic echocardiography and the biplane Simpson method.
Figure 4: Measurement of the left ventricular volume by 3D echocardiography.
Figure 5: Cardiac magnetic resonance images that show clear delineation of the endocardial border and allow accurate measurement of left ventricular mass, geometry and volume.
Figure 6: Measurement of strain in the left ventricle using tissue Doppler imaging and speckle tracking.
Figure 7: Proposed algorithm for cardiac imaging in patients with chronic kidney disease.

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Acknowledgements

D.Y.Y.C., D.G., N.A. and P.A.K. are in receipt of a Kidney Research UK project grant to investigate sudden cardiac death in dialysis patients; however, Kidney Research UK had no role in writing, reviewing or authorizing this manuscript and this article does not include data pertaining to the aforementioned study.

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  1. Institute of Population Health, Manchester Academic Health Science Centre, The University of Manchester, 46 Grafton Street, Manchester, M13 9NT, UK

    Diana Y. Y. Chiu, Darren Green, Smeeta Sinha & Philip A. Kalra

  2. Department of Cardiology, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK

    Nik Abidin

  3. Department of Renal Medicine, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK

    Smeeta Sinha & Philip A. Kalra

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D.Y.Y.C researched the material for this article. D.Y.Y.C., D.G., N.A., S.S. and P.A.K. contributed to discussion of content, writing and editing of the manuscript. P.A.K. managed the overall writing of the manuscript.

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Correspondence to Philip A. Kalra.

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Competing interests

D.Y.Y.C. has received honoraria for travel expenses from Amgen Bursary and Takeda to attend conferences. S.S. has received honoraria for speaking from Amgen, Fresenius and Shire, and receives an Amgen educational grant for the UK Calciphylaxis Study. P.A.K. has received honoraria for speaker meetings, advisory boards and other consultancy work from Amgen, Boehringer Ingelheim, Fresenius, MSD, Novartis, Otsuka, Pfizer, Pharmacosmos, Reata, Sanofi, Shire, Takeda and Vifor. His department has received educational grants from Amgen, Sanofi and Shire. D.G. and N.A. declare no competing interests.

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Chiu, D., Green, D., Abidin, N. et al. Cardiac imaging in patients with chronic kidney disease. Nat Rev Nephrol 11, 207–220 (2015). https://doi.org/10.1038/nrneph.2014.243

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