Abstract
ObjectivePatients with symptoms of heart failure and preserved left ventricular (LV) systolic function are commonly encountered in clinical practice especially in peritoneal dialysis (PD) patients. We hypothesized that adiposity might influence LV diastolic function through systemic inflammation in this specific group.MethodsWe designed a cross-sectional study in 173 prevalent PD patients. LV diastolic dysfunction was diagnosed by echocardiography. PD patient without LV diastolic dysfunction served as the control group. Serum inflammatory biomarkers were examined including tissue necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6). The location and amount of adipose tissue were assessed by computerized tomography (CT) at the level of the fourth lumbar vertebra.ResultsSubjects with LV diastolic dysfunction had higher levels of the pro-inflammation cytokines and more visceral and peritoneal fat (all P<0.001) than control subjects. A significant correlation was found between visceral adipose tissue and pro-inflammatory cytokines (r = 0.70; P<0.001). Multivariable regression analysis found that the relationship between visceral adipose tissue and LV diastolic dysfunction became insignificant when either TNF-α or IL-6 were introduced into the model, although TNF-α and IL-6 were both significantly associated with LV diastolic dysfunction even after adjusting for visceral fat (OR = 1.51; 95% CI = 1.09–2.02; P = 0.033 and OR = 1.62; 95% CI = 1.09–1.82; P = 0.031, respectively).ConclusionsLarger amounts of adipose tissue were associated with higher serum pro–inflammatory levels in PD patients, which might be related to the development of LV diastolic dysfunction. Modulating inflammatory reactions in PD patients can be a useful therapeutic approach for managing LV diastolic dysfunction.
Highlights
Left ventricular (LV) diastolic dysfunction has become an increasing concern in recent years
Of the 173 peritoneal dialysis (PD) subjects consecutively enrolled in this study, 59 were allocated to the LV diastolic dysfunction group, leaving 114 subjects to serve as the control group
Subjects allocated to the LV diastolic dysfunction group had significantly higher total amount of fat, including visceral fat, peritoneal fat, and retroperitoneal fat than subjects included in the control group
Summary
Left ventricular (LV) diastolic dysfunction has become an increasing concern in recent years. In patients with complex comorbidities, LV diastolic dysfunction could be an independent prognostic marker for patients with preserved LV contractility [2]. Patients with chronic kidney disease (CKD) stage 5 suffer from fluid overload and have a high prevalence of hypertension and LV hypertrophy (which is a physiological response to pressure and volume overload). Together, these factors contribute to the high prevalence of LV diastolic dysfunction in patients with CKD stage 5 [3,4]. There is scant information describing the mechanisms of LV diastolic dysfunction in end-stage renal disease (ESRD) patients
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