Acute Effects of Hemodialysis on Left and Right Ventricular Function: A Doppler Tissue Imaging Study

Year 2012, Volume: 37 Issue: 4, 215 - 222, 01.12.2012

Tansel Erol Fatma Yigit Hakan Altay Tolga Halil Koçum Muhammet Bilgi Abdullah Tekin Goknur Tekin Senol Demircan Dilek Torun Alpay Turan Sezgin

Abstract

Purpose: Doppler tissue imaging (DTI) allows noninvasive assessment of both left ventricular (LV) and right ventricular (RV) function. The aim of this study was to evaluate the effect of hemodialysis (HD) on LV and RV function using DTI. Method: Our study group included 30 patients on chronic HD program (mean age 45 15 years). Myocardial (Sm, Em, Am) and annular velocities (Ea, Aa) were measured in several cardiac territories before and after HD. Results: After HD, Ea significantly reduced from 10.8 3.4 cm/s to 9.6 2.4 cm/s (p = 0.029). Patients exhibited a lower Em following HD in all measured territories. Em/Am ratio was also reduced for each LV wall investigated after HD in all measured territories. At the RV segments, Sm, Em, and Am decreased significantly in all measured territories. Em of the anterior wall was positively related to ultrafiltration volume (r = 0.25, p = 0.006), whereas the decrease of Sm of RV basal segment correlated with a decrease of diastolic blood pressure (r = 0.23, p < 0.01). Conclusion: Our data indicate that a single HD session is associated with acute changes of systolic and diastolic parameters of LV and RV.

Keywords

tissue Doppler imaging; hemodialysis; left ventricular function; right ventricular function.

Hemodiyalizin Sağ ve Sol Ventrikül Fonksiyonlarına Akut Etkisinin Doku Doppler Görüntüleme ile Değerlendirilmesi

Abstract

Amaç: Doku Doppler görüntüleme, sağ ve sol ventrikülün fonksiyonlarının non-invazif değerlendirilmesine olanak verir. Çalışmamızın amacı, hemodiyalizin sağ ve sol ventrikül fonksiyonlarına akut etkisini non-invazif olarak doku Doppler görüntüleme aracılığıyla değerlendirmektir. Yöntem: Çalışmamızda kronik hemodiyaliz proğramına devam eden 30 hasta (ortalama yaş: 45 ± 15 yıl) incelendi. Hemodiyaliz öncesi ve sonrasında farklı kardiyak bölgelerden miyokardiyal (Sm, Em, Am) ve annüler (Ea, Aa) velositeler doku Doppler aracılığıyla ölçüldü. Bulgular: Hemodiyaliz sonrası, Ea anlamlı olarak 10.8 ± 3.4 cm/s"den 9.6 ± 2.4 cm/s" ye düştü (p = 0.029) Ölçüm yapılan tüm kardiyak segmentlerde hemodiyaliz sonrası ölçülen Em değeri anlamlı olarak daha düşük bulundu. Ölçüm yapılan her kardiyak segmentte ayrı ayrı olmak üzere Em/Am oranı hemodiyaliz sonrasında anlamlı derecede düştü. Sağ ventrikül değerlendirmesinde ölçüm yapılan tüm segmentlerde Sm, Em ve Am anlamlı olarak hemodiyaliz sonrası düştü. Ön duvar Em değeri, ultrafiltrasyon volümüyle pozitif ilişkili saptanırken; (r = 0.25, p = 0.006) sağ ventrikül bazal segmentinde Sm değerindeki düşüş diyastolik kan basıncı düşüşüyle korele bulundu. (r=0.23, p

Keywords

doku Doppler görüntüleme, hemodiyaliz, sol ventrikül fonksiyonları, sağ ventrikül fonksiyonları

References

• Foley RN, Parfrey PS, Sarnak MJ. Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis. 1998; 32: S112–S119.
• Karayaylali I, San M, Kudaiberdieva G,Niyazova-Karben Z, Seyrek N, Balal M et al. Heart rate variability, left ventricular functions, and cardiac autonomic neuropathy in patients undergoing chronic hemodialysis. Ren Fail. 2003; 25: 845–53.
• Govind SC, Roumina S, Brodin LA, Nowak J, Ramesh SS, Saha SK Differing myocardial response to a single session of hemodialysis in end-stage renal disease with and without type 2 diabetes mellitus and coronary artery disease. Cardiovasc Ultrasound. 2006; 4: 9.
• Sztajzel J, Ruedin P, Monin C, Stoermann C, Leski M, Rutishauser W et al. Effect of altered loading conditions during haemodialysis on left ventricular filling pattern. Eur Heart J. 1993; 14: 655–61.
• Sadler DB, Brown J, Nurse H, Roberts J. Impact of hemodialysis on left and tight ventricular Doppler diastolic filling indices. Am J Med Sci. 1992; 304: 83–90.
• Rozich JD, Smith B, Thomas JD, Zile MR, Kaiser J, Mann DL Dialysis- induced alterations in left ventricular filling: mechanisms and clinical significance. Am J Kidney Dis. 1991; 17: 277–85.
• Oguzhan A, Arinc H, Abaci A, Topsakal R, Kemal Eryol N, Ozdoğru I et al. Preload dependence of Doppler tissue imaging derived indexes of left ventricular diastolic function. Echocardiography. 2005; 22: 320–25.
• Lin SK, Hsiao SH, Lee TY, Huang WC, Hsu TL, Mar GY et al. Color M-mode flow propagation velocity: is it really preload independent? Echocardiography. 2005; 22: 636- 41.
• Hayashi SY, Rohani M, Lindholm B, Brodin LA, Lind B, Barany P et al. Left ventricular function in patients with chronic kidney disease evaluated by colour tissue Doppler velocity imaging. Nephrol Dial Transplant. 2006; 21: 125-32.
• Gorcsan J3rd, Deswal A, Mankad S, Mandarino WA, Mahler CM, Yamazaki N et al. Quantification of myocardial response to low-dose dobutamine using tissue Doppler echocardiographic measures of velocity and velocity gradient. Am J Cardiol. 1998; 81: 615–23.
• Hayashi SY, Brodin LA, Alvestrand A, Lind B, Stenvinkel P, Mazza do Nascimento M ,et al. Improvement of cardiac function after haemodialysis. Quantitative evaluation by colour tissue velocity imaging. Nephrol Dial Transplant. 2004; 19: 1497-506.
• Henry WL, DeMaria A, Gramiak R, King DL, Kisslo JA, Popp RL, et al. Report of the American Society of Echocardiography Committee on nomenclature and standards in twodimensional Circulation. 1980; 62: 212-7. echocardiography.
• Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy. Am J Cardiol. 1986; 57: 450–8.
• Agmon Y, Oh JK, McCarthy JT, Khandheria BK, Bailey KR, Seward JB. Effect of volume reduction on mitral annular diastolic velocities in hemodialysis patients. Am J Cardiol. 2000;85: 665–8.
• Nagueh SF, Middleton KJ, Kopelen HA, Zoghbi WA, Quiñones MA. Doppler tissue imaging: A noninvasive relaxation and estimation of filling pressure. J Am Coll Cardiol. 1997;30: 1527-33.
• Nagueh SF, Sun H, Kopelen HA, Middleton KJ, Khoury DS. Hemodynamic determinants of the mitral annulus diastolic velocities by tissue Doppler. J Am Coll Cardiol. 2001; 37: 278-85.
• Dincer I, Kumbasar D, Nergisoglu G, Atmaca Y, Kutlay S, Akyurek O, et al. Assessment of left ventricular diastolic function with Doppler tissue imaging: effects of preload and place of measurements. Int J Cardiovasc Imaging. 2002;18:155–60.
• Ie EH, Vletter WB, ten Cate FJ, Nette RW, Weimar W, Roelandt JR, et al. Preload dependence of new Doppler techniques limits their utility for left ventricular diastolic function assessment in hemodialysis patients. J Am Soc Nephrol. 2003; 14: 1858–62.
• Bauer F, Jamal F, Douillet R, Le Roi F, Bouchoule I, Bizet-Nafeh C,et al. Acute changes in load: effects of myocardial velocities measured by Doppler tissue imaging. Arch Mal Coeur Vaiss. 2001; 94: 1155–60.
• Fatema K, Hirono O, Takeishi Y, Nitobe J, Kaneko K, Ito M, et al. Hemodialysis improves myocardial interstitial edema and left ventricular diastolic function in patients with endstage renal disease: noninvasive assessment by ultrasonic tissue characterization. Heart Vessels. 2002; 16: 227-31.
• rinc H, Gunduz H, Tamer A, Ozhan H, Akdemir R, Saglam H,et al. Use of tissue Doppler to assess right ventricle function in hemodialysis patients. Am J Nephrol. 2005; 25: 256-61.
• Galetta F, Cupisti A, Franzoni F, Morelli E, Caprioli R, Rindi P, et al. Changes in heart rate variability in chronic uremic patients during ultrafiltration and hemodialysis. Blood Purif. 2001; 19: 395–400.