Left ventricular (LV) systolic and diastolic dysfunction is common and contributes to the increased cardiovascular morbidity and mortality in end-stage-renal-disease (ESRD). Hemodynamic alterations and shifts in volume status during hemodialysis acutely affect LV sizing and function. However, the effect of hemodialysis on novel, less volume-dependent, tissue Doppler-derived indices is not fully understood. This study evaluated acute changes in novel echocardiographic and tissue Doppler-derived indices of LV dysfunction during the first and mid-week dialysis session.Design and method:
Forty-one stable ESRD patients receiving thrice-weekly hemodialysis for at least 3 months underwent 2-dimensional echocardiographic and tissue-Doppler imaging evaluation with a Vivid 7 cardiac ultrasound device. Echocardiographic studies were performed shortly before and after the first and second weekly dialysis sessions.Results:
Body weight (1st session: 72.2 ± 12.6 vs 69.3 ± 12.5 kg, p < 0.001; 2nd session: 71.5 ± 12.7 vs 68.9 ± 12.5 kg, p < 0.001) and systolic blood pressure (1st session: 145.5 ± 21.6 vs 135.9 ± 23.5 mmHg, P < 0.05; 2nd session: 143.1 ± 19.8 vs 135.2 ± 20.4 mmHg, P < 0.05) were reduced during both dialysis sessions. Significant reductions in left atrial volume, LV end-systolic and end-diastolic volume were noted from pre-to post-dialysis in both sessions studied. LV systolic function assessed by LV ejection fraction, stroke volume and cardiac output, remained unchanged from pre- to postdialysis. In contrast, peak early (E) and the ratio of peak early to late mitral inflow velocity (E/A) were significantly decreased during both sessions (1st session: 1.15 ± 0.48 vs 0.92 ± 0.49, p = 0.001; 2nd session: 1.18 ± 0.48 vs 0.86 ± 0.48, p < 0.001). Peak tissue velocity around the mitral annulus during early diastole (mean Em) was significantly decreased during the 1st weekly session, but not during the mid-week dialysis (1st session: 0.188 ± 0.03 vs 0.167 ± 0.03 cm/s, p < 0.001; 2nd session: 0.188 ± 0.04 vs 0.179 ± 0.05 cm/s, p = 0.366). Mean isovolumetric relaxation time was stable in both occasions.Conclusions:
This study shows that hemodialysis improves LV sizing and reduces LV filling pressures during diastole. This effect seems to be more prominent during the first weekly dialysis session. Additional research efforts are warranted to fully elucidate whether these acute intradialytic alterations translate into long-term deterioration of cardiac function.