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Improvement of cardiac function after haemodialysis: Quantitative evaluation by colour tissue velocity imaging
Division of Baxter Novum, Department of Clinical Science, Karolinska Univ. Hospital.
Department of Clinical Physiology, Karolinska Institutet, Karolinska Univ. Hospital.
Division of Baxter Novum, Department of Clinical Science, Karolinska Univ. Hospital.
Department of Clinical Physiology, Karolinska Institutet, Karolinska Univ. Hospital.
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2004 (English)In: Nephrology, Dialysis and Transplantation, ISSN 0931-0509, E-ISSN 1460-2385, Vol. 19, no 6, 1497-1506 p.Article in journal (Refereed) Published
Abstract [en]

Background. Overhydration and accumulation of uraemic toxins may influence the myocardial function in haemodialysis (HD) patients. To evaluate cardiac function and the effects of fluid and solute removal during a single session of HD, colour tissue velocity imaging (TVI) was used. This new technique, which is less load dependent than conventional echocardiography, allows an objective quantitative assessment of myocardial contractility, contraction and relaxation.

Methods. Conventional echocardiographic and TVI images were recorded before and after a single HD session in 13 clinically stable HD patients (62 +/- 10 years, six males) and in 13 sex- and age-matched healthy controls. Myocardial tissue velocities (v; cm/s) for isovolumetric contraction (IVC), peak systole (PS), early (E) and late (A') diastolic filling and strain rate (SR) were measured.

Results. Left ventricular hypertrophy (LVH) was present in 12 patients. TVI gave additional information in comparison with conventional echocardiography. Before HD, PS (5.0 +/- 0.8 vs 6.0 +/- 1.2 cm/s, P < 0.05), E' (5.7 +/- 1.7 vs 7.3 +/- 2.0 cm/s, P < 0.05) and A' (6.6 +/- 1.7 vs. 8.3 +/- 2.9 cm/s, P < 0.05) velocities were lower in the patients than in the controls, indicating systolic and diastolic dysfunction. The HD session increased IVCv (4.0 +/- 1.7 to 5.5 +/- 1.9 cm/s; P < 0.001), PSv (5.0 +/- 0.8 to 5.7 +/- 0.8 cm/s; P < 0.05) and SR (0.7 +/- 0.2 to 0.9 +/- 0.2 1/s; P < 0.05) and decreased E/E' (16.7 +/- 7.7 to 12.2 +/- 4.0, P < 0.05), indicating improved systolic function and decreased LV filling pressure, respectively. Linear regression analysis demonstrated a dependency of systolic contraction (PSv) and contractility (IVCv) upon plasma levels of phosphate (r(2) = 0.70, P < 0.005, r(2) = 0.33, P < 0.01).

Conclusions. Using TVI, HD patients demonstrate myocardial dysfunction, which is found less frequently when using conventional echocardiography. The systolic function seems to be impaired by high plasma levels of phosphate and an increased Ca x P product. One single session of HD improved systolic function as indicated by increases in IVCv, PSv and SR. Further studies are needed to clarify if this effect of HD is due to the acute removal of fluid, the removal of solutes or both.

Place, publisher, year, edition, pages
2004. Vol. 19, no 6, 1497-1506 p.
Keyword [en]
diastolic function; end-stage renal disease; haemodialysis; phosphate; systolic function; tissue Doppler echocardiography
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:kth:diva-8354DOI: 10.1093/ndt/gfh205ISI: 000221868600026OAI: oai:DiVA.org:kth-8354DiVA: diva2:13653
Note
QC 20100809Available from: 2008-05-07 Created: 2008-05-07 Last updated: 2012-03-23Bibliographically approved
In thesis
1. Evaluation of Myocardial Function in Chronic Kidney Disease: A Colour Tissue Velocity Imaging Study
Open this publication in new window or tab >>Evaluation of Myocardial Function in Chronic Kidney Disease: A Colour Tissue Velocity Imaging Study
2008 (English)Doctoral thesis, comprehensive summary (Other scientific)
Abstract [en]

In patients with chronic kidney disease (CKD), overhydration, uremic toxins and left ventricular (LV) dyssynchrony are factors that may lead to LV dysfunction and conduction abnormalities and thus contribute to the high cardiac mortality. Colour tissue velocity imaging (TVI) allows a detailed quantitative analysis of cardiac function in CKD patients, opening new possibilities to evaluate longitudinal myocardial motion, rapid isovolumetric events, LV filling pressure and LV synchronicity. Aims: Using TVI technique: 1. To evaluate myocardial function disturbances and their relations to risk factors in CKD patients. 2. To assess LV synchronicity in HD patients, both at baseline and after HD, and 3. To study acute cardiac effects of HD and i.v. furosemide in HD patients. Methods: 40 predialysis CKD (stages I, II, III, IV and V) (Study II) and 59 HD (Studies I, III, IV and V) patients were studied. In both groups of patients LV function was evaluated using TVI, and in HD patients LV synchronicity was also assessed using tissue synchronization imaging (TSI). In HD patients the evaluations were performed before and after HD (Studies III and V) and i.v. furosemide infusion (Study IV). Results: 1. TVI detected: a) LV contraction disturbances in CKD patients with LVH and normal ejection fraction. b) An increase of LV contractility after HD. c) No changes in cardiac function induced by furosemide. 2. TSI detected the presence of LV dyssynchrony and its improvement after HD. 3. In CKD, cardiac dysfunction seemed to be related to high levels of PTH, phosphate and blood pressure. Conclusions: TVI is a sensitive tool for studies on cardiac function in CKD, allowing a detailed and accurate evaluation of disturbances in LV function. TVI also provides the possibility to follow the changes in LV function and synchronicity induced by different therapeutical interventions. The obtained information may contribute to a better management of CKD patients.

Place, publisher, year, edition, pages
Stockholm: KTH, 2008. 104 p.
Series
Trita-STH : report, ISSN 1653-3836 ; 2008:3
Keyword
Cardiac, Kidney, Tissue, Velocity
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:kth:diva-4729 (URN)978-91-7178-894-8 (ISBN)
Public defence
2008-05-28, lecture hall, 3-221, Alfred Nobels Allé 10, Fleminsberg, Huddinge., Fleminsberg, Huddinge., 09:00
Opponent
Supervisors
Note
QC 20100809Available from: 2008-05-07 Created: 2008-05-07 Last updated: 2010-08-09Bibliographically approved

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