Acute Haemodialysis-induced Changes in Tissue Doppler Echocardiography Parameters

Abstract

Cardiovascular diseases are common in patients with endstage renal disease (ESRD) and are the main causes of morbidity and mortality (1)(2)(3). A large body of evidence has accrued indicating that a portion of this cardiovascular damage may be due to haemodialysis (HD) (4,5). Notably, cardiovascular events contribute to increased death rates (10-to 20-fold) in HD patients compared to the general population, regardless of gender, race, and the general risk factors associated with heart disease (6). Short recurrent HD therapy is recognized to have a positive impact on haemodynamics, and approximately 20-30% can be convoluted by major intradialytic hypotension attacks (7). Previous studies have also shown that HD is known to induce haemodynamic instability through the development of subclinical myocardial ischemia, (8). Interestingly, sudden death appears to cause cardiovascular death in HD patients (9). There is evidence suggesting that cardiac arrhythmias are caused by abnormal ventricular morphology and function in this group of patients (10). Therefore, studying changes in cardiac functions induced by HD may be of significant clinical value.Cardiac function is routinely measured using diagnostic imaging techniques. Echocardiography (ECHO) is a conventional method that can measure systolic and diastolic functions of the right ventricle (RV) and left ventricle (LV). However, most traditional ECHO parameters of LV and RV diastolic and systolic functions are affected by alterations in loading conditions and are therefore called load-dependent (11). In HD patients, loading influence is principal for the functional examination of the heart. Certainly, the alterations in volume status cause significant changes in preload and afterload and ultimately effect the LV diastolic function measurements (12)(13)(14). The use of newer Doppler techniques that can examine cardiac function independent of volume status, such as tissue Doppler imaging (TDI), may prove useful for early diagnosis (12, 13). TDI can adequately measure relaxation and contraction velocities from the myocardium and has been recommended as quantitative and relatively load-independent (11,14). Throughout HD treatment, the intravascular volume of these patients is reduced a plausible group to investigate the role of acute preload Background: Tissue Doppler imaging (TDI) is a method that determines the tissue motion and velocity within the myocardium. Aims: To characterize acute haemodialysis (HD)-induced changes in TDI-derived indices for patients that have end-stage renal disease (ESRD). Study Design: Cross sectional study. Methods: Conventional echocardiography and TDI methods were applied to study ESRD patients (n=58) before and after HD. Pulmonary venous flow, mitral inflow, and TDI signals of the lateral and septal mitral annulus were examined for the determination of altered left-ventricular diastolic filling parameters. Flow velocities from early-(E) and late-atrial (A) peak transmitral; peak pulmonary vein systolic (S) and diastolic (D); and myocardia...

Impact of Elevated Parathormone Levels on the Severity of Pulmonary Hypertension in Patients with End Stage Renal Disease Undergoing Hemodialysis

“…Cardiological evaluation: all echocardiographic examinations were performed post dialysis, as soon as possible, when patients were at optimal dry weight, taking into account that several echocardiographic parameters are influenced by patients' hydration status [14]. Transthoracic echocardiography was performed with a Siemens echocardiograph, by the same skilled echocardiographist, in order to avoid inter-observer differences.…”

“…A normal PVR is under 1.5 Wood Units (WU). In this study, we considered PVR of over 2 WU as elevated and over 3 WU as significant for the diagnosis of PH [12,13,14,15]. Assessment of AVF flow volume (FV) in mL/min, was performed with the same equipment, with a 7 MHz linear probe, on a single longitudinal scan of the vessel, by using the cross-sectional area of the vessel (cm 2 ) and the mean velocity (cm/s) measured in pulsed Doppler at the site used to determine the area [16].…”