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Differing myocardial response to a single session of hemodialysis in end-stage renal disease with and without type 2 diabetes mellitus and coronary artery disease
Bhagwan Mahavir Jain Heart Center, Bangalore, India.
Karolinska University Hospital at Huddinge, Stockholm, Sweden.
KTH, School of Technology and Health (STH), Medical Engineering.
Karolinska University Hospital at Huddinge, Stockholm, Sweden.
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2006 (English)In: Cardiovascular Ultrasound, ISSN 1476-7120, E-ISSN 1476-7120, Vol. 4, no 9Article in journal (Refereed) Published
Abstract [en]

Background: Though hemodialysis (HD) acutely improves cardiac function, the impact of background diseases like coronary artery disease (CAD) and Type 2 diabetes (DM) in the setting of end-stage renal disease (ESRD) is not known. Tissue velocity echocardiography (TVE) offers a fast choice to follow changes in myocardial function after HD in ESRD with concomitant DM and/or CAD. Methods: 46 subjects (17 with ESRD, Group 1; 15 with DM, Group 2; 14 with DM+CAD, Group 3) underwent standard and TVE prior to and shortly after HD. Besides standard Doppler variables, regional myocardial systolic and diastolic velocities, as well as systolic strain rate were post processed. Results: Compared with pre-HD, post-HD body weight (kg) significantly decreased in all the three groups (51 ± 9 vs. 48 ± 8, 62 ± 10 vs.59 ± 10, and 61 ± 9 vs. 58 ± 9 respectively; all p < 0.01). Left ventricular end diastolic dimensions (mm) also decreased post- HD (46 ± 5 vs. 42 ± 7, 53 ± 7 vs. 50 ± 7, 51 ± 7 vs. 47 ± 8 respectively; all p < 0.01). Regional longitudinal peak systolic velocity in septum (cm/s) significantly increased post-HD in Group 1(5.7 ± 1.6 vs. 7.2 ± 2.3; p < 0.001) while remained unchanged in the other two groups. Similar trends were noted in other left ventricular walls. When the myocardial velocities (cm/s) were computed globally, the improvement was seen only in Group 1 (6.3 ± 1.5 vs. 7.9 ± 2.0; p < 0.001). Global early regional diastolic velocity (cm/s) improved in Group 1, remained unchanged in Group 2, while significantly decreased in Group 3(-5.9 ± 1.3 vs. -4.1 ± 1.8; p < 0.01). Global systolic strain rate (1/sec) increased in the first 2 Groups but remained unchanged (-0.87 ± 0.4 vs. -0.94 ± 0.3; p = ns) in Group 3. Conclusion: A single HD session improves LV function only in ESRD without coexistent DM and/or CAD. The present data suggest that not only dialysis-dependent changes in loading conditions but also co-existent background diseases determine the myocardial response to HD.

Place, publisher, year, edition, pages
2006. Vol. 4, no 9
Keyword [en]
adult; aged; article; clinical article; controlled study; coronary artery disease; data analysis; diastole; Doppler echocardiography; echocardiography; female; heart function; heart left ventricle enddiastolic volume; heart left ventricle wall; heart muscle; heart muscle contractility; heart ventricle septum; human; kidney failure; male; non insulin dependent diabetes mellitus; systole; treatment outcome; analysis of variance; chronic kidney failure; heart left ventricle function; middle aged; renal replacement therapy
National Category
Endocrinology and Diabetes Cardiac and Cardiovascular Systems Medical Laboratory and Measurements Technologies
URN: urn:nbn:se:kth:diva-7056DOI: 10.1186/1476-7120-4-9ScopusID: 2-s2.0-33644499451OAI: diva2:11949

QC 20100709

Available from: 2007-05-08 Created: 2007-05-08 Last updated: 2016-05-09Bibliographically approved
In thesis
1. Myocardial Effects of Type 2 Diabetes, Co-morbidities, and Changing Loading Conditions: a Clinical Study by Tissue Velocity Echocardiography
Open this publication in new window or tab >>Myocardial Effects of Type 2 Diabetes, Co-morbidities, and Changing Loading Conditions: a Clinical Study by Tissue Velocity Echocardiography
2007 (English)Doctoral thesis, comprehensive summary (Other scientific)
Abstract [en]

Ever since the validation of the tissue velocity echocardiography (TVE) technique more than a decade ago the modality has been used rather successfully in various clinical situations, at rest as well as during stress echocardiography. Hitherto, dobutamine stress echocardiography has been the hallmark of all forms of stress procedures, now with TVE, quantification of the longitudinal motions of the left ventricle shows far superiority, with improved sensitivity and specificity in the functional diagnosis of coronary artery disease. Morever there has been continued interest in this technique for even assessing subclinical myocardial systolic and diastolic function in clinical scenarios like diabetes, hypertension and chronic kidney disease.

The aim of the present study was to evaluate left ventricular myocardial functions by applying TVE in human subjects having type 2 diabetes with or without co-morbidities and during changing loading conditions. The effects of changing loading conditions were analyzed during hemodialysis and following oral administration of an AT1 receptor blocker. The studied subjects included individuals with diabetes as well as those with associated hypertension, coronary artery disease, microalbuminuria and end-stage renal disease. All patients with type 2 diabetes and co-morbidities underwent TVE enhanced dobutamine stress echocardiography while load dependant left ventricular functions were analyzed at rest. There were 270 subjects in the study of type 2 diabetes and associated cardiovascular diseases and 101 subjects in the study of changing loading conditions.

Patients with type 2 diabetes revealed subclinical left ventricular dysfunction characterized by reduced functional reserve. This influence becomes quantitatively more pronounced in the presence of coexistent coronary artery disease and hypertension. The coexistence of type 2 diabetes and hypertension appears to have additive negative effect on both systolic and diastolic left ventricular function, even in the absence of coronary artery disease. The presence of microalbuminuria in type 2 diabetes patients does not worsen diminished myocardial functional reserve. A single session of hemodialysis improves left ventricular function in patients with end-stage renal disease only in the absence of type 2 diabetes and co-morbidities, while a single dose of an AT1 receptor blocker valsartan results in reduction of afterload and, subsequently, in improvement of left ventricular function. TVE appears to be a sensitive tool for objective assessment of left ventricular function and can be successfully applied for the clinical evaluation of the effect of type 2 diabetes and co-morbidities on myocardial performance.

Place, publisher, year, edition, pages
Stockholm: KTH, 2007. 74 p.
Trita-STH : report, ISSN 1653-3836 ; 2007:2
National Category
Biomedical Laboratory Science/Technology
urn:nbn:se:kth:diva-4359 (URN)978-91-7178-647-0 (ISBN)
Public defence
2007-05-25, Plan 4, Novum Research Park, Flemingsberg, 09:00
QC 20100709Available from: 2007-05-08 Created: 2007-05-08 Last updated: 2010-10-01Bibliographically approved

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