Abstract
Background: Moderate therapeutic hypothermia (TH) is a well-recognized cardio-protective strategy. The instillation of fluid into the peritoneum provides an opportunity to deliver moderate hypothermia as primary prevention against cardiovascular events. We aimed to to investigate both cardiac perfusion consequences (overall blood flow and detailed assessment of perfusion heterogeneity) and subsequently simulate the associated arrhythmic risk for patients undergoing peritoneal dialysis (PD) induced TH.Methods: Patients underwent high resolution myocardial perfusion scanning using high resolution 256 slice CT scanning, at rest and with adenosine stress. The first visit using the patient's usual PD regimen, on the second visit the same regime was utilized but with cooled peritoneal dialysate at 32°C. Myocardial blood flow (MBF) was quantified from generated perfusion maps, reconstructed in 3D. MBF heterogeneity was assessed by fractal dimension (FD) measurement on the 3D left ventricular reconstruction. Arrhythmogenicity was quantified from a sophisticated computational simulation using a multi-scale human 3D ventricle wedge electrophysiological computational model.Results: We studied 7 PD patients, mean age of 60 ± 7 and mean vintage dialysis of 23.6 ± 17.6 months. There were no significant different in overall segmental MBF between normothermic condition (NT) and TH. MBF heterogeneity was significantly decreased (−14%, p = 0.03) at rest and after stress (−14%, p = 0.03) when cooling was applied. Computational simulation showed that TH allowed a normalization of action potential, QT duration and T wave.Conclusion: TH-PD results in moderate hypothermia leading to a reduction in perfusion heterogeneity and simulated risk of non-terminating malignant ventricular arrhythmias.
Highlights
Patients receiving peritoneal dialysis (PD) are faced with the equivalent survival challenges as patients treated with hemodialysis (HD), both in terms of the rate and dominance of cardiac sudden death as the main modality of cardiovascular mortality [1, 2]
myocardial blood flow (MBF) heterogeneity was significantly decreased (−14%, p = 0.03) at rest and after stress (−14%, p = 0.03) when cooling was applied
therapeutic hypothermia (TH)-PD results in moderate hypothermia leading to a reduction in perfusion heterogeneity and simulated risk of non-terminating malignant ventricular arrhythmias
Summary
Patients receiving peritoneal dialysis (PD) are faced with the equivalent survival challenges as patients treated with hemodialysis (HD), both in terms of the rate and dominance of cardiac sudden death as the main modality of cardiovascular mortality [1, 2]. At present there are no therapies identified able to provide primary prevention of sudden cardiac death events in patients receiving dialysis. Lu and co-workers demonstrated increased heterogeneity of stress myocardial blood flow (MBF) in hypertrophic cardiomyopathy patients is associated with an increased risk of ventricular arrhythmias [8]. Heterogenous myocardial perfusion at the microvascular level has been proposed as a mechanism in arrhythmia and of sudden cardiac death. We aimed to to investigate both cardiac perfusion consequences (overall blood flow and detailed assessment of perfusion heterogeneity) and subsequently simulate the associated arrhythmic risk for patients undergoing peritoneal dialysis (PD) induced TH
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