Echocardiographic and Doppler Findings in Patients with Chronic Renal Failure on Hemodialysis

Abstract

Two-dimensional and Doppler echocardiography were performed in 48 patients (31 men) aged 55 ± 17 years with chronic renal failure (CRF) on hemodialysis for a mean of 3.9 years. Systemic hypertension was present in 44 patients, and a systolic and diastolic murmur in 42 and 6 patients, respectively. Serum creatinine was 10.6 ± 3.1 mg/dl, BUN 69 ± 28 mg/dl and hemoglobin 9 ± 2 g/dl. Left ventricular (LV) hypertrophy was seen in 22 (46%) patients, LV dilatation in 24 (50%) and systolic LV dysfunction in 25 (52%) patients. Pericardial effusion, usually small, was detected in 26 (54%) patients. Peak forward flow velocities (m/s) across each valve by Doppler were: 1.6 ± 0.7 (aortic), 1.0 ± 0.3 (mitral), 0.6 ± 0.2 (tricuspid), and 1.1 ±0.3 (pulmonic). Only 2 patients had significant aortic stenosis (peak velocity ≥ 4.0 m/s). Peak velocities had no correlation with patients’ age, heart rate, duration of hemodialysis, creatinine, or BUN. Aortic regurgitation was detected in 21 (45%) patients, mitral in 38 (79%), tricuspid in 28 (58%) and pulmonary regurgitation 15 (35%) patients. Mitral regurgitation was more common in patients with mitral annular calcification and those with LV dysfunction. Regurgitation was usually mild but multiple valve regurgitation was seen in 31/48 (65 %) patients, involved 3 valves in 13 and all 4 valves in 8 patients. Thus, patients with CRF on hemodialysis have: (1) a high incidence of LV dysfunction, mitral annular calcification and pericardial effusion, (2) increased aortic valve flow velocities but rarely stenosis, and (3) multi valvular regurgitation, more commonly mitral and tricuspid, and usually mild.

Role of Arterial Hypertension in Left Ventricle Hypertrophy in Hemodialysis Patients: An Echocardiographic Study

“…Hemodialysis patients frequently present cardiac hypertrophy associated, in some cases, with dilation and reduction ofleft ven tricle (LV) function [ 1 ]. Arterial hypertension is a well-known cause of cardiac hypertrophy in the nonuremic population.…”

“…Arterial hypertension is a well-known cause of cardiac hypertrophy in the nonuremic population. However, its role in the cardiac abnormalities of dialysis patients remains controversial [1][2][3][4][5][6][7] and the prevalence of LV hypertrophy has been shown to be similarly increased in both normotensive and hypertensive hemodialysis pa tients [5][6][7], As many as 80% of patients entering a dial ysis program may present hypertension [8], Although satisfactory control of blood pres sure will eventually be achieved in most cases, this is not necessarily followed by rapid and complete resolution of hypertensive heart dis ease [9], Therefore, the high prevalence of LV hypertrophy in normotensive dialysis sub jects may possibly be explained by previous hypertension.…”