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[Cardiopathy in uremic dialyzed patients: transthoracic and transesophageal echocardiography].

BACKGROUND
Despite progress and improvement in the dialysis modalities, cardiovascular disease remains the leading cause of death in patients receiving chronic hemodialysis therapy.


METHODS
To determine the prevalence of myocardial abnormalities among these patients, thirty-nine patients (22 males and 17 females, ranging in age from 20 to 87; mean age 61.38 +/- 15.04) underwent echocardiographic study. Twenty-seven were also examined by transesophageal echocardiogram. The morphology and function of the left ventricle as well as the presence of pericardial effusion, valvular disease and calcification were examined. The data obtained from transthoracic and transesophageal echocardiography were then compared.


RESULTS
The patients on chronic hemodialysis treatment showed a high prevalence of valvular disease (observed in 90% of the cases, but rarely hemodynamically relevant), calcifications (74%) and left ventricular hypertrophy (74%). Impaired cardiac function (diastolic dysfunction in 74% of the patients; systolic dysfunction in 36%) and left atrial enlargement (50%) were frequently observed. The incidence rates of pericardial effusion (7%) left atrial thrombi (7%) and atherosclerotic plaques of coronary arteries (10%) were uncommon.


CONCLUSIONS
Transesophageal echocardiography is more accurate than transthoracic echocardiography in evaluating the presence of cardiac calcification (particularly of mitral apparatus), valvular leaflet mobility minor valvular regurgitation, left atrial and auricolar thrombi and spontaneous echocontrast, aortic and interatrial septum abnormalities and coronary artery atherosclerotic plaque.