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A single session of haemodialysis improves left ventricular synchronicity in patients with end-stage renal disease: A pilot tissue synchronization imaging study
KTH, School of Technology and Health (STH), Medical Engineering.
Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital.
Department of Laboratory Medicine, Division of Clinical Physiology, Karolinska Institutet, Karolinska University Hospital.
Department of Laboratory Medicine, Division of Clinical Physiology, Karolinska Institutet, Karolinska University Hospital.
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2008 (English)In: Nephrology, Dialysis and Transplantation, ISSN 0931-0509, E-ISSN 1460-2385, Vol. 23, no 11, 3622-3628 p.Article in journal (Refereed) Published
Abstract [en]

Background. Mechanical left ventricular (LV) dyssynchrony impairs cardiac function in patients with heart failure and LV hypertrophy (LVH) and may be a factor contributing to the high incidence of cardiac deaths in patients with end-stage renal disease (ESRD).

Objectives. To evaluate the possible presence of LV dyssynchrony in ESRD patients, and acute effect of haemodialysis (HD) on LV synchronicity using a tailored echocardiographic modality, tissue synchronization imaging (TSI).

Methods. In 13 clinically stable ESRD patients (7 men; 65 +/- 10 years) with LVH, echocardiography data were acquired before and after a single HD session for subsequent off-line TSI analysis enabling the retrieval of regional intraventricular systolic delay data. Six basal and six midventricular LV segments were evaluated. Dyssynchrony was defined as a regional difference in time to peak systolic velocity > 105 ms.

Results. Before HD, all patients had at least one dyssynchronous LV segment. The percentage of delayed segments correlated positively to LV end-diastolic diameter (r = 0.68, P < 0.05). HD induced a substantial decrease in the percentage of delayed segments from 36 +/- 25% to 19 +/- 14% (P < 0.01), reduced average maximal mechanical systolic LV delay from 300 +/- 89 to 225 +/- 116 ms (P < 0.05) and completely normalized LV synchronicity in three patients (23%).

Conclusions. LV dyssynchrony appears to be present frequently in ESRD patients with LVH. The severity of LV dyssynchrony correlates with LV end-diastolic diameter and decreases after a single session of HD suggesting a mechanistic relevance of volume overload and possibly other toxins accumulating in HD patients.

Place, publisher, year, edition, pages
2008. Vol. 23, no 11, 3622-3628 p.
Keyword [en]
end-stage renal disease; haemodialysis; left ventricular hypertrophy; systolic dyssynchrony; tissue synchronization imaging
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:kth:diva-8356DOI: 10.1093/ndt/gfn311ISI: 000260153600039Scopus ID: 2-s2.0-54149099213OAI: oai:DiVA.org:kth-8356DiVA: diva2:13655
Note
QC 20100809. Uppdaterad från accepted till published (20100809).Available from: 2008-05-07 Created: 2008-05-07 Last updated: 2017-12-14Bibliographically 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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