[Cardiac alterations caused by renal failure].

Cardiac disease is the most common cause of death in patients with endstage renal disease. It was assumed that the high rate of cardiovascular mortality was based on accelerated atherosclerosis. Recently published articles, however, demonstrated that only 30-50% of all cardiac deaths in patients with uremia was due to myocardial infarction. On the other hand 30-40% of all patients with renal insufficiency, angina pectoris and documented ischemia have normal coronary arteries. Therefore, it is suggested that in patients with chronic uremia apart from accelerated atherosclerosis further abnormalities of the heart lead to myocardial ischemia. Recently published papers report functional and structural changes, which affect myocardial perfusion reserve. These structural changes include left ventricular hypertrophy, interstitial myocardial fibrosis, and microvascular disease.