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: Few studies have addressed the description of serial changes in left ventricular mass (LVM) and relevant risk factors. The aims of our study were to describe trends in left ventricular (LV) structure and function derived from echocardiographic measurements over a 10-year period in Fresenius Nephrocare Dialysis Center in Iaşi and to compare the results with those obtained on a smaller group 4 years ago. Three hundred and thirty-four hemodialyzed patients were enrolled at baseline, between January 1999 and March 2009. Echocardiography was performed at inclusion and several times for each patient during this period, until the end of the study. Mean values of the biochemical parameters (hemoglobin, serum proteins, calcium, phosphate) at the time of the echocardiographic examination were calculated and included in the final analysis. Outcome in dialysis was 70.5% alive at the end of the study. The most important improvement was observed in LV mass index: at the 4th echocardiography, the mean LVMi was 144.8 vs. 156.0 g/m(2) at the 2nd echocardiographic examination vs. 167.2 g/m(2) at the first echocardiographic examination (mean decrease 3.34 ± 9.6 g/m(2)/month). Significant results were obtained by comparing LVMi only in patients with all 4 echocardiographies: left ventricular hypertrophy regression was statistically significant, from 172.7 g/m(2) at the 1st echocardiography to 146.0 g/m(2) at the 4th, i.e. 15.4% reduction of LVMi. Delta LVMi significantly correlated only with changes in hemoglobin (P < 0.05).There was a significant regression of the relative wall thickness from an average of 0.46 to 0.42 (P < 0.05). Our study proves that regression of LVH in hemodialyzed patients is possible and constitutes a must-achieve objective in dialysis centers.International Urology and Nephrology 12/2011; 43(4):1161-9. · 1.33 Impact Factor
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ABSTRACT: Fibroblast growth factor-23 (FGF-23) is a phosphorus-regulating substance. Circulating FGF-23 levels increase markedly in dialysis patients and are independently associated with increased risk of mortality. Given the fact that cardiovascular disease is the leading cause of death in dialysis patients, the aim of this study was to test if elevated FGF-23 levels might be associated with left ventricular mass index (LVMI) and left ventricular index of myocardial performance (MPI) in maintenance haemodialysis patients. In this cross-sectional study, plasma FGF-23 concentrations were measured using a C-terminal human enzyme-linked immunosorbent assay kit, and echocardiography was performed in 128 maintenance haemodialysis patients (65 women and 63 men, mean age: 55.5 ± 13 years, mean haemodialysis vintage: 52 ± 10 months, all patients are on haemodialysis thrice a week) and 40 control subjects (21 women and 19 men; mean age: 54 ± 11 years) with normal kidney function (eGFR > 90 mL/min/1.73 m(2)). Serum FGF-23 levels were elevated when compared with age- and gender-matched controls with preserved kidney function [(median 958 RU/mL; interquartile range 106-1894 RU/mL) vs (median 27 RU/mL; interquartile range 11-35), P < 0.0001]. Patients with a history of coronary artery disease and aortic valve calcifications had higher levels of log FGF-23 than those without (3.00 ± 0.22 vs 2.82 ± 0.26, P = 0.002; and 3.06 ± 0.19 vs 2.83 ± 0.26, P = 0.0001, respectively). Patients with MPI > 0.47 had higher serum FGF-23 levels than those with MPI < 0.47 [(median 1156 RU/mL; interquartile range 396-1894 RU/mL) vs (median 657 RU/mL; interquartile range 106-1102 RU/mL), P = 0.0001]. Significant correlations were recorded between log FGF-23 levels and LVMI (r = 0.281, P = 0,007) and MPI (r = 0.555, P = 0.0001). Multivariable-adjusted regression analyses revealed that increased log FGF-23 concentrations were independently associated with increased left ventricular mass index (30% increase per 1-SD increase in log FGF-23 concentration, P = 0.002) and increased MPI (28.5% increase per 1-SD increase in log FGF-23 concentration, P = 0.001). Plasma FGF-23 concentration is independently associated with LVMI and MPI in maintenance haemodialysis patients. Further prospective studies are needed to clarify whether increased serum FGF-23 level is a marker or a potential mechanism for left ventricular involvement in patients with end-stage renal disease.Nephrology Dialysis Transplantation 04/2011; 26(4):1346-54. · 3.37 Impact Factor
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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.