Influence of hemodialysis on echocardiographic Doppler indices of the left ventricle: changes in parameters of systolic and diastolic function and Tei index.
ABSTRACT Numbers of previous studies have evaluated the influence of dialysis-induced altered loading condition on Doppler-echocardiographic indices of left ventricle in patients with chronic renal failure. It has been suggested that most of Doppler-derived indices are preload-dependent. On the other hand, there are no studies that have evaluated the influence of hemodialysis on Tei index; a new Doppler-derived index obtained by isovolumetric contraction time plus isovolumetric relaxation time divided by ejection time. The aim of this study is to evaluate whether Tei index is also influenced by dialysis-induced altered loading condition as well as other Doppler-derived indices, and to assess the possibility that Tei index is also preload-dependent.
Thirty-two patients with chronic renal failure (21 men and 11 women, aged 48-93 years) on maintenance hemodialysis were evaluated for Doppler-derived indices before and after hemodialysis. We studied parameters of diastolic function (peak velocities of mitral inflow in early diastole (E) and late diastole from atrial filling (A), ratio of A to E (A/E), deceleration time (DT), and isovolumetric relaxation time (IRT)), parameters of systolic function (ejection time (ET), pre-ejection period (PEP), ratio of PEP to ET (PEP/ET), and isovolumetric contraction time (ICT)) and Tei index.
Hemodialysis resulted in significant decreases in E, increase in A/E, prolongation of IRT, no change in A and DT; significant prolongation of ICT and PEP, shortening of ET, and increase in PEP/ET and a significant increase in Tei index (0.42 +/- 0.16 vs 0.51 +/- 0.16, p < 0.0001). When patients were subdivided into 2 groups based on weight loss after hemodialysis (> or = 1.5 kg and < 1.5 kg), only the group that lost > or = 1.5 kg had significant change in Tei index before and after hemodialysis (0.40 +/- 0.15 vs 0.52 +/- 0.17, p = 0.0002).
This study demonstrates that not only most of Doppler-derived indices but also Tei index is affected by dialysis-induced altered loading condition and suggests that Tei index is possibly preload-dependent.
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ABSTRACT: Left ventricular (LV) diastolic function has been causally deteriorated on hypotensive episodes during hemodialysis (HD). The influence of intravascular volume deterioration and arterial pressure reduction on LV function in patients without hypotensive episodes during HD has not been adequately studied. 23 patients on HD were studied for 48±35 months, whose mean age was 50±12 years, their mean body mass index was 24±4kg/m2 and their mean fluid retention between HD sessions 2.2±1.1 kgr. We used 2D and Doppler echocardiography before and after the same HD session. The following parameters were measured: a) end-diastolic (LVED) and end-systolic LV diameters, left atrial diameter (LA) and fraction shortening (FS) b) isovolumic relaxation (IVRT) and contraction (ICT) time, deceleration time (DT), E and A waves of the mitral inflow and ejection time (ET) of the LV outflow velocity. The following indices were calculated: E/A ratio, myocardial performance index (MPI) using the (IVRT+ICT)/ET formula, mean arterial pressure (MAP), the % reduction in MAP and the reduction in intravascular volume after HD. Stroke volume (SV) and corresponding cardiac output (CO), were calculated from the LV outflow velocity waveform. All patients demonstrated systolic arterial pressure at the level of ≥90mmHg and normal FS before HD, while they had demonstrated restrictive LV diastolic filling before HD. MAP, SV, CO, LVED, LA, E wave and E/A decreased while IVRT increased after HD (p
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ABSTRACT: Hyperviscosity syndromes are disor-ders of infrequent prevalence in which changes of rhe-ological characteristics cause increased resistance to blood flow, endothelial dysfunction, tissue ischemia and bleeding. Signs of hyperviscosity syndrome beco-me clinically overt at the point of 4 centipoise units. We present a case of patient with hyperviscosity syn-drome due to Waldenstrom's macroglobulinemia with negative records on earlier cardiovascular illnesses. Laboratory diagnostic and standard echocardiography did not show any deviation towards increased cardio-vascular risk, heart failure or ischemic heart disease. However, unique clinically significant change that co-uld be indirectly related to hyperviscosity syndrome was found with the myocardium performance index (MPI). Tei-index showed median value of 0.75 corre-sponding to severe grades of myocardial dysfunction earlier described in the literature for other entities. Comprehensive roles of rheological changes in rela-tion to echocardiography, pathophysiology of myocar-dial performance and cardiovascular continuum might be interesting point for further investigations.SANAMED. 12/2013; Index copernicus(8):137-141.
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ABSTRACT: Patients on long-term maintenance hemodialysis (HD) are at high risk of developing cardiovascular disease and suffering various cardiovascular complications during HD. The purpose of this study was to evaluate the influence of changing loading conditions on the myocardial performance index (MPI) in patients on long-term HD and to specify an optimal level of fluid loss during HD that would maintain stable global cardiac function. The study consisted of 52 patients with end-stage renal failure (ESRF), mean age 56±11.7 y, range: 25-80 y, on regular HD. For each patient a complete echocardiographic-Doppler examination was performed before and after HD. Systolic and diastolic parameters of left ventricular function were measured, and the myocardial performance index (MPI) was calculated. The MPI was significantly prolonged after HD (0.47±0.15 before HD versus 0.59±0.16 after HD, p < 0.001). Mean change in body weight during HD was 2.1±0.86 kg. The MPI did not change significantly in patients with intradialytic weight loss up to 1.75 kg. The MPI value seems to be independent of acute preload changes only when fluid loss is less than 1.75 kg. A 1.75-kg fluid loss during HD seems to be the optimal goal. In ESRF patients on HD, the MPI seems to be a good indicator of global left ventricular function and potentially a valuable aid in the effort to maintain optimal fluid balance.Clinical Cardiology 12/2010; 33(12):E45-50. · 1.83 Impact Factor