Evidence map›Paper›PMID 40663318›Full record

ArticleJournal of nephrology2025

Potentially reversible severe cardiac involvement in thrombotic microangiopathies with malignant hypertension.

Marco Allinovi, Silvia Menale, Valentina Querin, Leonardo Caroti, Giulia Antognoli, Calogero Lino Cirami, Niccolò Marchionni, Valentina Scheggi

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Article in Journal of nephrology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Observational
  2. Article
  3. Observational
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Marco AllinoviNephrology, Dialysis and Transplantation Unit, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy.
Silvia MenaleDivision of General Cardiology, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy. silvia.menale@unifi.it.ORCID http://orcid.org/0000-0003-3904-6463
Valentina QuerinNephrology, Dialysis and Transplantation Unit, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy.
Leonardo CarotiNephrology, Dialysis and Transplantation Unit, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy.
Giulia AntognoliNephrology, Dialysis and Transplantation Unit, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy.
Calogero Lino CiramiNephrology, Dialysis and Transplantation Unit, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy.
Niccolò MarchionniDivision of General Cardiology, Careggi University Hospital, Largo Brambilla, 3, 50134, Florence, Italy.
Valentina ScheggiDivision of Cardiovascular and Perioperative Medicine, Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThrombotic microangiopathy (TMA) represents a pathological response to endothelial damage, caused by genetic or acquired factors. It includes conditions like thrombotic thrombocytopenic purpura, atypical hemolytic uremic syndrome (aHUS), and secondary TMAs. Malignant hypertension can both result from and trigger TMA. This study aims to identify risk factors for severe cardiac involvement, defined as a left ventricular ejection fraction ≤ 50%, in patients with concomitant TMA and malignant hypertension, and to investigate the evolution of cardiac anomalies post-TMA remission.

methodsWe retrospectively collected data of 33 patients with TMA and malignant hypertension, admitted to our hospital between January 2014 and December 2023. Patients were followed up to monitor kidney function, blood pressure, and hematological parameters, and those with severe cardiac involvement at admission underwent repeated echocardiograms. Genetic testing for complement factors was performed to identify aHUS cases.

resultsSevere cardiac involvement was diagnosed in 9 patients, all of whom exhibited left ventricular hypertrophy and varying degrees of diastolic dysfunction and valve regurgitation. Patients with severe cardiac involvement had significantly higher interventricular septal and posterior wall thickness at admission. Over a mean follow up of 42 months, all patients with severe cardiac involvement showed recovery of left ventricular systolic function. Patients with severe cardiac involvement had a higher incidence of respiratory failure [5/9 (56%) vs 2/24 (8%) patients, p = 0.003] and kidney failure [7/9 (78%) vs 8/24 (33%) patients, p = 0.022].

conclusionsSevere cardiac involvement in TMA associated with malignant hypertension is common but largely reversible. Early identification and tailored treatment can lead to improved outcomes. This study highlights the importance of comprehensive cardiac assessment in managing TMA patients with malignant hypertension.

Indexed as

Heart DiseasesHypertension, MalignantHypertrophy, Left VentricularThrombotic MicroangiopathiesAdultAgedFemaleHumansMaleMiddle AgedRetrospective StudiesRisk FactorsSeverity of Illness IndexVentricular Function, LeftHemolytic uremic syndromeMalignant hypertensionReversible left ventricular systolic dysfunctionThrombotic microangiopathy

Identifiers

PMID40663318

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.