CARDIAC VALVULAR CALCIFICATION AND STATE OF THE MYOCARDIUM IN PATIENTS IN THE PREDIALYSIS PERIOD OF CHRONIC KIDNEY DISEASE

THE AIM of the investigation was to determine the character of relationship between mitral valve (MV) calcification and aortal valve (AV) calcification and the state of myocardium in patients in the predialysis period of chronic kidney disease (CKD). PATIENTS AND METHODS. The investigation included 317 patients in the predialysis period with CKD of the I-V stages, 46.1% of men and 53.9% of women, mean age 50.7±15.2 years with Doppler-echocardiography performed. Patients with chronic glomerulonephritis made up 30.7%, with diabetic nephropathy - 29.4%, with essential hypertension -17.7%, with other diseases -22.0%. RESULTS. Cardiac valvular calcification was revealed in 22.1% of the examined patients: AV - in 6.3%, MV - 4.1% and of both valves in 11.7%. In calcification of AV and MV their stenosis was noted more often (p<0.001 and p= 0.002 respectively) as well as perivalvular regurgitation of the1 degree and higher (p=0.002 and p=0.053). Patients with calcification of AV and  MV had greater diameter of the aorta (p=0.005), left (p<0.001) and right atriums (p<0.001), right ventricle (p=0.007), thickness of walls of the right (p<0.001) and left (p<0.001) ventricles, greater diameter and pressure in the pulmonary artery (p<0.001), more pronounced diastolic dysfunction by the E/A index (p<0.001), higher pressure gradients on MV (p<0.001) and AV (p<0.001) and flows through MV (p<0.001) and AV (p<0.001). By the data of multifactor analysis the following independent factors are associated with valvular calcification:  diameter of the atriums (p<0.001), maximum gradient of pressure on AV (p<0.001), MV (p<0.001), the E/A index (p<0.001), the aortal regurgitation degree (p=0.004), LA diameter (p=0.041). CONCLUSION. MV and AV calcification, irrespective of other factors, results in insufficiency of the valves, increased maximum gradients and maximum flows on AV and MV, dilatation of the atriums, LA, diastolic dysfunction.

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