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

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\xa0weeks. 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\xa0(60.6\u2009±\u20094.3\xa0mL/m 2 vs 64.2\u2009±\u20095.1\xa0mL/m 2 , p \u2009=\u20090.99) or PAT\xa0index (60.0\u2009±\u20095.4\xa0mL/m 2 vs 53.2\u2009±\u20095.9\xa0mL/m 2 , p \u2009=\u20090.42) between INHD and CHD groups. Over 52\xa0weeks, EAT\xa0index and PAT index\xa0did not change significantly in INHD and CHD groups ( p \u2009=\u20090.21 and 0.14, respectively), and the changes in EAT\xa0index and PAT\xa0index did not differ significantly between INHD and CHD groups ( p \u2009=\u20090.30 and 0.16, respectively). Overall, changes in EAT index\xa0inversely 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\xa0index inversely correlated with changes in LVESVI, LVMI and positively correlated with changes in LVEF. There were no correlations between changes in EAT index\xa0or PAT index\xa0with changes in albumin, LDL, triglycerides, troponin-I, FGF-23, or NT-proBNP levels over 52\xa0weeks (all p \u2009>\u20090.30). Conclusions INHD was not associated with any changes in EAT\xa0index and PAT\xa0index over 12\xa0months. Changes in EAT\xa0index were not significantly associated with changes in markers of LV remodeling, nutrition, myocardial injury, fibrosis, volume status. In contrast, changes in PAT\xa0index, 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.