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Heart. 2019 Jun 25. pii: heartjnl-2019-315138. doi: 10.1136/heartjnl-2019-315138. [Epub ahead of print]

Coronary microvascular dysfunction: a key step in the development of uraemic cardiomyopathy?

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Birmingham Cardio-Renal Group, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.
Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK.
Department of Nephrology, Queen Elizabeth Hospital Birmingham, Birmingham, UK.
Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand.


The syndrome of uraemic cardiomyopathy, characterised by left ventricular hypertrophy, diffuse fibrosis and systolic and diastolic dysfunction, is common in chronic kidney disease and is associated with an increased risk of cardiovascular morbidity and mortality. The pathophysiological mechanisms leading to uraemic cardiomyopathy are not fully understood. We suggest that coronary microvascular dysfunction may be a key mediator in the development of uraemic cardiomyopathy, a phenomenon that is prevalent in other myocardial diseases that share phenotypical similarities with uraemic cardiomyopathy such as hypertrophic cardiomyopathy and heart failure with preserved ejection fraction. Here, we review the current understanding of uraemic cardiomyopathy, highlight different methods of assessing coronary microvascular function and evaluate the current evidence for coronary microvascular dysfunction in chronic kidney disease.


myocardial disease

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Competing interests: None declared.

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