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Cardiac MRI measurements of pericardial adipose tissue volumes in patients on in-centre nocturnal hemodialysis

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Abstract

Background

Conversion from conventional hemodialysis (CHD) to in-centre nocturnal hemodialysis (INHD) is associated with left ventricular (LV) mass regression, but the underlying mechanisms are not fully understood. Using cardiac MRI (CMR), we examined the effects of INHD on epicardial adipose tissue (EAT) and paracardial adipose tissue (PAT), and the relationships between EAT, PAT and LV remodeling, biomarkers of nutrition, myocardial injury, fibrosis and volume.

Methods

We conducted a prospective multicenter cohort study of 37 patients transitioned from CHD to INHD and 30 patients on CHD (control). Biochemical markers and CMR were performed at baseline and 52 weeks. CMR images were analyzed by independent readers, blinded to order and treatment group.

Results

Among 64 participants with complete CMR studies at baseline (mean age 54; 43% women), there were no significant differences in EAT index (60.6 ± 4.3 mL/m2 vs 64.2 ± 5.1 mL/m2, p = 0.99) or PAT index (60.0 ± 5.4 mL/m2 vs 53.2 ± 5.9 mL/m2, p = 0.42) between INHD and CHD groups. Over 52 weeks, EAT index and PAT index did not change significantly in INHD and CHD groups (p = 0.21 and 0.14, respectively), and the changes in EAT index and PAT index did not differ significantly between INHD and CHD groups (p = 0.30 and 0.16, respectively). Overall, changes in EAT index inversely correlated with changes in LV end-systolic volume index (LVESVI) but not LV end-diastolic volume index (LVEDVI), LV mass index (LVMI), and LV ejection fraction (LVEF). Changes in PAT index inversely correlated with changes in LVESVI, LVMI and positively correlated with changes in LVEF. There were no correlations between changes in EAT index or PAT index with changes in albumin, LDL, triglycerides, troponin-I, FGF-23, or NT-proBNP levels over 52 weeks (all p > 0.30).

Conclusions

INHD was not associated with any changes in EAT index and PAT index over 12 months. Changes in EAT index were not significantly associated with changes in markers of LV remodeling, nutrition, myocardial injury, fibrosis, volume status. In contrast, changes in PAT index, which paradoxically is expected to exert less paracrine effect on the myocardium, were correlated with changes in LVESVI, LVMI and LVEF. Larger and longer-term studies may clarify the role of PAT in cardiac remodeling with intensified hemodialysis.

ClinicalTrials.gov Identifier

NCT00718848.

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Funding

This study was supported by an operating grant from the Canadian Institutes of Health Research and a grant-in-aid from Heart and Stroke Foundation. The study sponsor had no role in the study design, data collection or analysis, interpretation of the findings, writing the manuscript, or the decision to submit the manuscript for publication. ClinicalTrials.gov Identifier: NCT00718848.

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Authors and Affiliations

  1. Department of Medicine, University of Toronto, Toronto, Canada

    Sean Cai, Ron Wald, Kim A. Connelly & Andrew T. Yan

  2. Division of Nephrology, St Michael’s Hospital, Toronto, Canada

    Ron Wald

  3. Department of Medical Imaging, St Michael’s Hospital, University of Toronto, Toronto, Canada

    Djeven P. Deva, Anish Kirpalani & Andrew T. Yan

  4. Division of Nephrology, St. Paul’s Hospital, Vancouver, Canada

    Mercedeh Kiaii

  5. Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong, China

    Ming-Yen Ng

  6. Toronto Joint Department of Medical Imaging, University Health Network, Toronto, Canada

    Gauri R. Karur

  7. Division of Cardiology, St. Michael’s Hospital, 30 Bond Street, Donnelly 6-034, Toronto, ON, M5B 1W8, Canada

    Oblugbenga Bello, Zhuo Jun Li, Kim A. Connelly & Andrew T. Yan

  8. Department of Medical Imaging, St Paul’s Hospital, Vancouver, Canada

    Jonathon Leipsic

  9. Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada

    Laura Jimenez-Juan

Authors
  1. Sean Cai
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  2. Ron Wald
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  3. Djeven P. Deva
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  7. Oblugbenga Bello
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  8. Zhuo Jun Li
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  11. Anish Kirpalani
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  12. Kim A. Connelly
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  13. Andrew T. Yan
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Corresponding author

Correspondence to Andrew T. Yan.

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Conflict of interest

The authors have no conflicts of interest to disclose.

Ethical approval

The study was approved by the research ethics boards of St. Michael's hospital and St. Paul’s Hospital (Vancouver, British Columbia).

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All patients provided their written informed consent.

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Cai, S., Wald, R., Deva, D.P. et al. Cardiac MRI measurements of pericardial adipose tissue volumes in patients on in-centre nocturnal hemodialysis. J Nephrol 33, 355–363 (2020). https://doi.org/10.1007/s40620-019-00665-4

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  • DOI: https://doi.org/10.1007/s40620-019-00665-4

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