PubMed · 7119521
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1982. [Myocardial protection].. https://pubmed.ncbi.nlm.nih.gov/7119521/
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PURPOSE OF REVIEW: To describe the relationship of renal disease and metabolic syndrome with cardiovascular disease and explore the role of toxic solutes retained due to renal impairment as mediators of cardiovascular risk. RECENT FINDINGS: Metabolic syndrome and chronic kidney disease are related. Chronic kidney disease is partly caused by, but also mediates, some of the adverse effects of metabolic syndrome. Uremic toxins with potent effects have been identified. Examples include the nitric oxide synthase inhibitor asymmetric dimethyl arginine - this substance accumulates as renal function declines and has a strong relationship with cardiovascular events and mortality in a variety of populations. The effect of asymmetric dimethyl arginine in causing arterial stiffness, a phenomenon which has been linked with risk of vascular disease, offers a mechanistic explanation for the importance of this substance. SUMMARY: A pathophysiology that links renal impairment with cardiovascular risk has long been suspected and is being elucidated through the effects of uremic toxins.
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Our understanding of the physical underpinnings of the assessment of cardiac function is becoming increasingly sophisticated. Recent developments in cardiac ultrasound permit exploitation of many of these newer physical concepts with current echocardiographic machines. This review will first focus on the current approach to the assessment of cardiovascular hemodynamics by cardiac ultrasound. The next focus will be the assessment of global cardiac mechanics in systole and diastole. Finally, relationships between the cardiac structure and regional myocardial function, and the way regional function can be quantified by ultrasound, will be presented. This review also discusses the clinical impact of echocardiography and its future directions and developments.