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Evaluation of Myocardial Function in Chronic Kidney Disease: A Colour Tissue Velocity Imaging Study
KTH, School of Technology and Health (STH), Medical Engineering.
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 [en]
Cardiac, Kidney, Tissue, Velocity
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:kth:diva-4729ISBN: 978-91-7178-894-8 (print)OAI: oai:DiVA.org:kth-4729DiVA: diva2:13656
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
List of papers
1. Analysis of mitral annulus motion measurements derived from M-mode, anatomic M-mode, tissue Doppler displacement, and 2-dimensional strain imaging
Open this publication in new window or tab >>Analysis of mitral annulus motion measurements derived from M-mode, anatomic M-mode, tissue Doppler displacement, and 2-dimensional strain imaging
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2006 (English)In: Journal of the American Society of Echocardiography, ISSN 0894-7317, E-ISSN 1097-6795, Vol. 19, no 9, 1092-1101 p.Article in journal (Refereed) Published
Abstract [en]

Background: Left ventricular longitudinal shortening plays an important role in cardiac contraction and can be measured by the mitral annulus motion (MAM) toward the cardiac apex. MAM can be evaluated by conventional M-mode, anatomic M-mode (AM-mode), tissue Doppler displacement (TDD), and 2-dimensional strain imaging (2DSI). Objective: The aim of the study was to compare these 4 different methods for measuring MAM. Methods: MAM was evaluated in 25 patients by M-mode, AM-mode, TDD, and 2DSI. Two walls (septal and lateral) in apical 4-chamber view were analyzed. Results. The angle correction between M-mode and AM-mode was significantly higher in the lateral wall (septum 2.2+/-1.6 vs lateral 4.1+/-1.6 degrees, P<0.01). However, with angle correction up to 8 degrees, the measurements obtained were not significantly different from those obtained by M-mode. No significant differences were found among 2DSI. M-mode, and AM-mode either, although all of them were significantly higher in comparison with TDD measurements in both septal (M-mode [11.0 +/- 2.4 nun], AM-mode [11.8 +/- 2.4 mm], 2DSI [11.0 +/- 3.4 mm] vs TDD [9.2 +/- 3.3 mm], P<.01) and lateral (M-mode [11.9 +/- 2.3 min], AM-mode [12.4 +/- 2.8 mm], 2DSI [10.4 +/- 3.9 mm] vs TDD [8.9 +/- 3.0 mm], P<.05) walls. The +/- 2SD variation from the mean difference in septal and lateral walls were, respectively, between: M-mode and TDD, -2.4 to 5.9 and -2.2 to 8.2 mm; M-mode and 2DSI, -5.7 to 5.7 and -5.8 to 8.7; AM-mode and TDD, -2.5 to 5.6 and -2.7 to 9.6; AM-mode and 2DSI, -5.7 to 5.87 and -5.9 to 9.8 and TDD and 2DSI, -3.2 to 6.6 and -5.3 to 8.4. Conclusions: AM-mode and M-mode measurements did not differ significantly. Despite the good correlation among all methods they were not interchangeable. TDD measurements were significantly lower than M-mode, AM-mode, and 2DSI measurements. M-mode and AM-mode are angle dependent and can, therefore, underestimate or overestimate MAM. The new method of 2DSI is promising because it tracks natural acoustic markers and is not angle dependent and, therefore, measures the true local tissue motion.

Keyword
atrioventricular plane displacement, myocardial-infarction, ejection, fraction, left-ventricle, echocardiography, tracking, velocity
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:kth:diva-15993 (URN)10.1016/j.echo.2006.04.014 (DOI)000240584100003 ()2-s2.0-33748067330 (Scopus ID)
Note
QC 20100525Available from: 2010-08-05 Created: 2010-08-05 Last updated: 2017-12-12Bibliographically approved
2. Left ventricular function in patients with chronic kidney disease evaluated by colour tissue Doppler velocity imaging
Open this publication in new window or tab >>Left ventricular function in patients with chronic kidney disease evaluated by colour tissue Doppler velocity imaging
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2006 (English)In: Nephrology, Dialysis and Transplantation, ISSN 0931-0509, E-ISSN 1460-2385, Vol. 21, no 1, 125-132 p.Article in journal (Refereed) Published
Abstract [en]

Background. Cardiovascular disease is the leading cause of death in chronic kidney disease (CKD) patients. Tissue Doppler velocity imaging (TVI) is a new objective method that accurately quantifies myocardial tissue velocities, deformation, time intervals and left ventricular (LV) filling pressure. In this study, TVI was compared with conventional echocardiography for the assessment of left ventricular (LV) function in pre-dialysis patients with different stages of CKD. The results obtained by TVI were used to analyse possible relationships between LV function and clinical factors such as hyperparathyroidism and hypertension that could influence LV function.

Methods. Conventional echocardiography and TVI images were recorded in 40 patients (36 men and 4 women, mean age 60 +/- 14 years, range 28-80 years) and in 27 healthy controls (21 men and 6 women, mean age 58 +/- 17 years, range 28-82 years). Twenty-two patients had mild/moderate CKD (CCr > 29 ml/min; Group 1) and 18 patients had severe CKD (CCr <= 29 ml/min; Group 2). Using TVI, the myocardial tissue velocities (v; cm/s) for isovolumetric contraction (IVCv), peak systole (PSv), early (E') and late (A') diastolic filling velocities as well as strain rate (SR), mitral annulus displacement, isovolumetric relaxation time (IVRT) and LV filling pressure were estimated using TVI. The average of six LV wall measurements was used to evaluate LV global function.

Results. Using TVI, we were able to identify significantly more patients with diastolic dysfunction than using conventional echocardiography (33 vs 26, P < 0.05). There was no difference in the prevalence of diastolic dysfunction between Group 1 and 2. However, using TVI, Group 2 CKD patients had lower E' velocities (6.2 +/- 1.9 vs 8.0 +/- 2.9 cm/s, P < 0.05) and higher IVRT (137.4 +/- 13 vs 88.2 +/- 26 ms, P < 0.001) in comparison with controls, indicating more accentuated diastolic dysfunction. Systolic blood pressure (SBP) was associated with E' velocities (rho = -0.68, P < 0.005) and E'/A' was strongly associated with SBP (rho = -0.60; P < 0.01) and PTH (rho = -0.64, P < 0.005) in Group 2. Using conventional echocardiography, there was no difference in the prevalence of systolic and diastolic dysfunction between patients with and without LVH. However, using TVI, patients with LVH had significantly lower IVCv (2.8 +/- 1.3 vs 3.8 +/- 1.5 and 3.8 +/- 1.5 cm/s, P < 0.05) and PSv (5.5 +/- 1.0 vs 6.3 +/- 1.2 and 6.4 +/- 1.3 cm/s, P < 0.05) compared with patients without LVH and controls, and they also had lower E' velocities (7.1 +/- 2.7 vs 8.0 +/- 2.9 cm/s, P < 0.05) compared with controls, indicating disturbances in systolic and diastolic left ventricular function.

Conclusions. TVI provided additional information on left ventricular function in CKD patients. In patients with advanced renal failure, TVI revealed more accentuated diastolic dysfunction associated with increased systolic blood pressure (SBP) and increased levels of PTH. TVI also demonstrated disturbances in contractility and contraction in patients with LVH, which could not be detected by conventional echocardiography.

Keyword
chronic kidney disease; parathyroid hormone; predialysis; tissue Doppler echocardiography
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:kth:diva-8353 (URN)10.1093/ndt/gfi075 (DOI)000234436100026 ()2-s2.0-30344456711 (Scopus ID)
Note
QC 20100809Available from: 2008-05-07 Created: 2008-05-07 Last updated: 2017-12-14Bibliographically approved
3. Improvement of cardiac function after haemodialysis: Quantitative evaluation by colour tissue velocity imaging
Open this publication in new window or tab >>Improvement of cardiac function after haemodialysis: Quantitative evaluation by colour tissue velocity imaging
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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.

Keyword
diastolic function; end-stage renal disease; haemodialysis; phosphate; systolic function; tissue Doppler echocardiography
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:kth:diva-8354 (URN)10.1093/ndt/gfh205 (DOI)000221868600026 ()
Note
QC 20100809Available from: 2008-05-07 Created: 2008-05-07 Last updated: 2017-12-14Bibliographically approved
4. Acute effects of low and high intravenous doses of furosemide on myocardial function in anuric haemodialysis patients: a tissue Doppler study
Open this publication in new window or tab >>Acute effects of low and high intravenous doses of furosemide on myocardial function in anuric haemodialysis patients: a tissue Doppler study
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2008 (English)In: Nephrology, Dialysis and Transplantation, ISSN 0931-0509, E-ISSN 1460-2385, Vol. 23, no 4, 1355-1361 p.Article in journal (Refereed) Published
Abstract [en]

Background. In patients with pulmonary oedema and preserved renal function, furosemide has not only a renal, but also a vascular effect, causing a rapid fall in left ventricular filling pressure accompanied by an increase in venous compliance. Previous studies have shown conflicting findings regarding the vascular effects of furosemide in patients with end-stage renal disease (ESRD). The objective of our study was to investigate whether furosemide induces changes in central cardiac haemodynamics in anuric ESRD patients, using conventional echocardiography and colour tissue Doppler velocity imaging (TVI), a new quantitative and sensitive method. Methods. Repeated low doses (40 mg followed by an additional dose of 40 mg after 30 min) of i.v. furosemide were administered to 12 (61.6 +/- 16 years, 7 men) and a high dose (250 mg) of i.v. furosemide to 6 (64.1 +/- 3.6 years, 5 men) clinically stable anuric haemodialysis (HD) patients. Conventional two-dimensional echocardiography and colour TVI images were recorded immediately before (0 min) the furosemide infusion in both groups, and in the group receiving the repeated low-dose infusion (at 0 and 30 min), 10, 20, 30, 40, 50 and 70 min after the administration of the first infusion. In the group receiving the single high dose of furosemide the ultrasound investigation was repeated 10, 20, 30 and 40 min after the infusion. The myocardial tissue velocities (v; cm/s) for isovolumetric contraction (IVC), peak systole (PS), early (E') and late (A') myocardial diastolic filling velocities were measured in the left ventricle (LV) at six sites (infero-septal, antero-lateral, inferior, anterior, infero-lateral and antero-septal walls) at the basal region. IVC time (IVCT), IV relaxation time (IVRT), PS time (PSt), RR interval, mitral annulus motion (MAM), strain rate (SR), left ventricular filling pressure (E/E') and cardiac output were also measured. The average of the different walls was used to evaluate global function. Right ventricle (RV) dynamics was evaluated from measurements of IVC velocity (IVCv), peak systolic velocity (PSv), E' and A' from the RV free wall. Results. No significant changes in cardiac output, IVCv, PSv, SR, MAM, E', A', E'/A', IVRT and LV filling pressure were observed, indicating that neither 40 mg (plus additional 40 mg after 30 min) nor 250 mg of furosemide had any measurable effects on LV filling pressure and LV and RV systolic and diastolic function. Conclusions. In anuric HD patients, low and high doses of furosemide had no significant effects on central cardiac haemodynamics. Therefore, the use of furosemide infusion in anuric ESRD patients with acute pulmonary oedema is not supported by the results of this study.

Keyword
anuria, colour tissue Doppler velocity, imaging echocardiography, furosemide, haemodialysis, systolic function, left-ventricular contractility, congestive-heart-failure, stress, echocardiography, quantitative assessment, filling pressures, renal-failure, strain-rate, velocity, quantification, diagnosis
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:kth:diva-17413 (URN)10.1093/ndt/gfm805 (DOI)000254472400044 ()18048421 (PubMedID)2-s2.0-42949156922 (Scopus ID)
Note
QC 20100525Available from: 2010-08-05 Created: 2010-08-05 Last updated: 2017-12-12Bibliographically approved
5. A single session of haemodialysis improves left ventricular synchronicity in patients with end-stage renal disease: A pilot tissue synchronization imaging study
Open this publication in new window or tab >>A single session of haemodialysis improves left ventricular synchronicity in patients with end-stage renal disease: A pilot tissue synchronization imaging study
Show others...
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.

Keyword
end-stage renal disease; haemodialysis; left ventricular hypertrophy; systolic dyssynchrony; tissue synchronization imaging
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:kth:diva-8356 (URN)10.1093/ndt/gfn311 (DOI)000260153600039 ()2-s2.0-54149099213 (Scopus ID)
Note
QC 20100809. Uppdaterad från accepted till published (20100809).Available from: 2008-05-07 Created: 2008-05-07 Last updated: 2017-12-14Bibliographically approved

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