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Case Reports
. 2021 Jun 3;21(1):271.
doi: 10.1186/s12872-021-02076-5.

Rapid decline in cardiac function in diabetic patients with calcified coronary artery disease undergoing hemodialysis: two case reports

Hironobu Yamaoka  1 , Taira Yamamoto  2 , Daisuke Endo  3 , Akie Shimada  3 , Satoshi Matsushita  3 , Tohru Asai  3 , Atsushi Amano  3
Affiliations
Case Reports

Rapid decline in cardiac function in diabetic patients with calcified coronary artery disease undergoing hemodialysis: two case reports

Hironobu Yamaoka et al. BMC Cardiovasc Disord. .

Abstract

Background: Clinical symptoms of patients on dialysis do not match the signs of coronary disease progression, making the prediction of the true progression of their medical condition in clinical settings difficult. Emergency and concomitant surgeries are significant risk factors of mortality following open-heart surgery in patients on hemodialysis.

Case presentation: We report two cases of successful coronary artery bypass grafting (CABG) in patients on dialysis with a history of cardiac surgery. The first case describes a 65-year-old woman who had undergone aortic valve replacement 2 years ago and was hospitalized urgently, because of a sudden decline in heart function and hypotension. She had moderate mitral regurgitation with right ventricular pressure of 66 mmHg and poor left ventricular function [left ventricular ejection fraction (LVEF), 40%]. Cineangiography revealed an increase in the rate of stenosis in the left main trunk, from 25 to 99% at admission, in addition to 100% occlusion in proximal left anterior descending artery (LAD) and 99% stenosis in the proximal left circumflex artery (LCX). We inserted an intra-aortic balloon pump preoperatively and performed emergency surgery (Euro II risk score, 61.7%; Society of Thoracic Surgeons (STS) risk score, 56.3%). The second case described a 78-year-old man who had undergone surgery for left atrial myxoma 4 years ago and was hospitalized urgently due to dyspnea, chest discomfort, and an LVEF of 44% (Euro II risk score, 40.7%; STS risk score, 33.2%). Cineangiography revealed an increase in the rate of stenosis in the proximal LAD, from 25% (4 years ago) to 90% at admission, in addition to 99% stenosis in proximal LCX and 95% stenosis in the posterolateral branch of LCX. Both patients underwent emergency CABG due to unstable hemodynamics and decreased left ventricular function despite regular dialysis. The surgeries were successful, and the patients were discharged without any complications.

Conclusions: In patients with multiple comorbidities and those who undergo dialysis treatment, calcified lesions in coronary arteries can progress severely and rapidly without any symptoms, including chest pain. Close outpatient management involving nephrologists and the cardiovascular team is necessary for patients on dialysis.

Keywords: Calcification; Coronary artery bypass grafting; Coronary artery disease; Diabetes mellitus; Hemodialysis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Preoperative electrocardiogram in Case 1. Electrocardiogram (ECG) showing normal sinus rhythm and ST depression in V4-V6
Fig. 2
Fig. 2
Preoperative chest radiography and computed tomography in Case 1. Chest radiograph showing a cardiothoracic ratio (CTR) of 57%, and computed tomography (CT) demonstrates a severely calcified coronary artery
Fig. 3
Fig. 3
Coronary angiogram in Case 1. a Two years previously. No stenosis in the right coronary artery (RCA), 25% stenosis in the left main trunk (LMT), and 25% occlusion in the middle left anterior descending artery (LAD). b At admission. No stenosis in the RCA, 99% stenosis in the LMT, 100% occlusion in the proximal LAD, and 99% stenosis in the proximal left circumflex artery (LCX)
Fig. 4
Fig. 4
Preoperative electrocardiogram in Case 2. Electrocardiogram (ECG) showing normal sinus rhythm with Q waves in leads II, III, and aVF, and ST segment depression in V5-V6
Fig. 5
Fig. 5
Preoperative chest radiography and computed tomography in Case 2. Chest radiography and computed tomography (CT) showing a CTR of 72% and severely calcified coronary arteries
Fig. 6
Fig. 6
Coronary angiogram in Case 2. a Four years previously. A right coronary artery hypoplastic artery with no stenosis in the left anterior descending artery (LAD) and left circumflex artery (LCX). b At admission. The images show 90% stenosis in the proximal LAD, 99% stenosis in the proximal LCX, and 90% stenosis in the posterolateral branch of the LCX
Fig. 7
Fig. 7
Postoperative three-dimensional computed tomography (3D-CT) in Case 2. All grafts are patent
See this image and copyright information in PMC

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References

    1. Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M, Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol. 1990;15:827–32. doi: 10.1016/0735-1097(90)90282-T. - DOI - PubMed
    1. Braun J, Oldendorf M, Moshage W, Heidler R, Zeitler E, Luft FC. Electron beam computed tomography in the evaluation of cardiac calcification in chronic dialysis patients. Am J Kidney Dis. 1996;27:394–401. doi: 10.1016/S0272-6386(96)90363-7. - DOI - PubMed
    1. Noordzij M, Korevaar JC, Bos WJ, Boeschoten EW, Dekker FW, Bossuyt PM, et al. Mineral metabolism and cardiovascular morbidity and mortality risk: peritoneal dialysis patients compared with haemodialysis patients. Nephrol Dial Transplant. 2006;21:2513–20. doi: 10.1093/ndt/gfl257. - DOI - PubMed
    1. Gürel OM, Demircelik MB, Bilgic MA, Yilmaz H, Yilmaz OC, Cakmak M, et al. Association between red blood cell distribution width and coronary artery calcification in patients undergoing 64-multidetector computed tomography. Korean Circ J. 2015;45:372–7. doi: 10.4070/kcj.2015.45.5.372. - DOI - PMC - PubMed
    1. Turkmen K, Erdur FM, Ozcicek F, Ozcicek A, Akbas EM, Ozbicer A, et al. Platelet-to-lymphocyte ratio better predicts inflammation than neutrophil-to-lymphocyte ratio in end-stage renal disease patients. Hemodial Int. 2013;17:391–6. doi: 10.1111/hdi.12040. - DOI - PubMed

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