Left ventricular function in chronic renal failure.

Abstract

Left ventricular function was studied in 14 patients with end-stage chronic renal failure using non-invasive methods (echocardiography and systolic time intervals). Patients were divided into 3 groups. Group 1 consisted of 5 patients who were normotensive at the time of study and group 2 of 7 patients who were hypertensive when studied. Group 3 consisted of 2 patients: one was recetving propranolol and the other, studied 302 days after renal transplantation, was receiving digitalis for recurrent episodes of cardiac failure.All except the patient receiving propranolol had normal left ventricular function in systole with norwal measurements offractional fibre shortening (% AS, EF) and normal measurements relating to the velocity of ventricular contraction (mean Vcf, mean velocity of posterior wall motion). Stroke volume and cardiac output were normal in some patients but were increased in patients with fluid overload. Early diastolic compliance of the left ventricle seemed to be normal except in the patient with recurrent cardiacfailure. The study provided no evidence for the existence of a specific uraemic cardiomyopathy.

Measurement of systolic time intervals.

“…In recent years, the use of the measurement of systolic time intervals (STI) as a measure of cardiac contractility has become increasingly more popular (Dobbs, Kenyon & Dobbs, 1977;Lewis, Milne & Goldberg, 1976;Sykes, Wright, Malins & Pentecost, 1977 The data leading to these regression equations were obtained from a large number of normal male subjects (similar data were obtained from female subjects) with the recordings being made between 08.00 and 10.00 h, although the latter time could be extended to 15.00 h. This technique has been applied to investigations into the pharmacodynamic effects of digoxin and beta methyl digoxin in man (Das, Talmers & Weissler, 1977;Hinderling & Garrett, 1977) where the shortening of QS2 or LVET has been used as a measure of the cardiac effects of these drugs. However position following a 10 min rest period.…”

Effect of hemodialysis on left ventricular function. Dissociation of changes in filling volume and in contractile state.

“…Earlier human studies of hemodynamic changes after hemodialysis in patients with chronic renal failure were confined to the demonstration of alterations in cardiac output, heart rate, systemic arterial pressure, and peripheral vascular resistance (7)(8)(9)(10)(11). The advent of noninvasive techniques has permitted a more comprehensive evaluation of left ventricular function in patients in chronic renal failure and of the effects of hemodialysis (12)(13)(14)(15)(16)(17). Studies using systolic time intervals (12)(13)(14), echocardiography (14)(15)(16), and radionuclide fourth, or fifth intercostal space, depending on the size of the subject.…”

“…The advent of noninvasive techniques has permitted a more comprehensive evaluation of left ventricular function in patients in chronic renal failure and of the effects of hemodialysis (12)(13)(14)(15)(16)(17). Studies using systolic time intervals (12)(13)(14), echocardiography (14)(15)(16), and radionuclide fourth, or fifth intercostal space, depending on the size of the subject. An optimal short-axis circular or almost circular image at the widest point of the left ventricle below the tips of the mitral valve leaflets was centralized within the display arc and the M-mode cursor was directed across the left ventricular cavity at the widest point.…”

Digitalis in Chronic Renal Insufficiency

“…To date there is no consensus whether a specific uremic cardiomyopathy exists [6,7], Myocardial function was found to be either normal [8][9][10][11] or depressed [12,13] in pa tients with renal insufficiency. In the plasma of uremic animals, factors were found [14] which depressed cardiac inotropy.…”