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Kidney Week

Abstract: TH-PO216

A Systematic Review and Meta-Analysis of Myocardial Fibrosis in CKD and ESKD Assessed by Cardiac MRI T1 Mapping

Session Information

Category: Hypertension and CVD

  • 1602 Hypertension and CVD: Clinical

Authors

  • Chandramohan, Deepak, The University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Rajasekaran, Rhoshini, The University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Konda, Raghunandan, The University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Pujari, Ashwini S., The University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Avula, Sreekant, University of Minnesota Twin Cities, Minneapolis, Minnesota, United States
Background

Non-atherosclerotic fibrotic changes to the cardiac myocardium occur early in Chronic Kidney Disease (CKD) and End Stage Kidney Disease (ESKD) patients. Uremic myocardial fibrosis can lead to arrhythmias and heart failure. T1 mapping technique in Cardiac MRI (CMR) estimates myocardial fibrosis and offers a non-invasive way to characterize the severity of cardiac remodeling.

Methods

A systematic search was done in PubMed, Google Scholar, Embase, and Web of Science from inception to February 2023. Studies were divided according to scanner field strength (1.5 or 3 Tesla). The random effects model was used to calculate pooled mean, 95% confidence interval, standard error (SE), and standardized mean difference (SMD). The heterogeneity between study-specific estimates was assessed by the I2 statistic.

Results

The initial search retrieved 765 studies. From these, 25 studies met the inclusion criteria that had 697 CKD (mean age of 55.5 years; 65.5% males; mean eGFR of 41 mL/min/1.73m2) and 658 ESKD patients on dialysis (mean age of 55.6 years; 63.3% males; mean dialysis duration of 5 years). The mean native septal T1 is 998.2ms (970-1026.3) for CKD and 1267.4ms (1217.8-1317.1) in ESKD patients. The SMD of native T1 measurements in CKD vs. controls is 1.09 (0.73-1.46), and SMD for ESKD vs. controls is 1.12 (0.85-1.38).

Conclusion

CKD and ESKD patients with preserved LVEF have increased T1 values indicating an increased fibrosis burden. T1 mapping can be used in the early detection of cardiomyopathy and as a risk-stratification tool. Large, randomized trials are needed to confirm these findings and find long-term effects of dialysis on cardiac fibrosis.

Forest plots of LVEF, Native T1 measurements in CKD and ESKD