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: Doppler tissue imaging (DTI) has been proposed as a tool for evaluation of diastolic function. Controversy exists regarding whether DTI measurements are influenced by preload. To determine the influence of preload reduction on DTI, we studied 17 patients (mean age 17 +/- 1.82 years) with end-stage renal disease and without overt heart disease, using DTI before and after hemodialysis (HD). Peak systolic (S), peak early diastolic (Ea), and peak late diastolic (Aa) velocities, and tissue Doppler-derived Tei index (the sum of the isovolumetric contraction and relaxation times divided by the ejection time: TDE-Tei), were determined for each patient from the septum, and lateral mitral and lateral tricuspid annuluses. The Ea of the mitral annulus (12.47 +/- 4.51 cm/s to 10.71 +/- 5.18 cm/s, P = 0.023), isovolumetric contraction time (ICT) of the mitral annulus (85.29 +/- 33.66 ms to 68.76 +/- 17.24 ms, P = 0.031) and Aa of the lateral tricuspid annulus (15.94 +/- 6.46 cm/s to 12.47 +/- 3.85 cm/s, P = 0.044) decreased significantly after HD. With weight loss of more than 1.5 kg, significant changes in the TDE-Tei index of the septum was observed (P = 0.036). From these findings, it is concluded that the Ea of the mitral annulus and the Aa of the tricuspid annulus are decreased by acute preload reduction. The TDE-Tei index is affected by preload reduction of more than 1.5 kg; therefore, it seems necessary to consider the preload status of HD patients when myocardial function is assessed by DTI.Pediatric Nephrology 07/2008; 23(10):1803-8. · 2.94 Impact Factor
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ABSTRACT: Anthracyclines are antineoplastic agents that are effective against solid tumors and hematological malignancies. However, drug-induced cardiotoxicity imposes dose limitations. Myocardial damage due to anthracyclines has been assessed by measuring left ventricular ejection fraction (LVEF) or fraction shortening (FS) by echocardiography and criteria for discontinuing treatment have been established based on these indexes. However, cardiotoxicity is already irreversible when either LVEF or FS fulfills these criteria. The Tei-index has recently been established to assess combined systolic and diastolic myocardial function during echocardiography. It can also detect small changes in cardiac function. We therefore surmised that the Tei-index would reflect early myocardial damage induced by anthracyclines. We treated 23 patients with the anthracycline, doxorubicin (DXR), and examined them at least twice during the treatment. An additional dose of DXR significantly correlated with a change in the Tei-index (DeltaTei-index). In contrast, a change in LVEF did not correlate with increased doses of DXR. The DeltaTei-index did not correlate with either LVEF or the Tei-index before treatment. These results suggested that the DeltaTei-index is a more sensitive indicator of early cardiotoxicity induced by anthracyclines than LVEF regardless of its value before treatment.Heart and Vessels 12/2007; 22(6):393-7. · 2.13 Impact Factor
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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