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Acute effects of low and high intravenous doses of furosemide on myocardial function in anuric haemodialysis patients: a tissue Doppler study
KTH, School of Technology and Health (STH), Medical Engineering.
Division of Renal Medicine, Karolinska Institutet, Karolinska University Hospital.
KTH, School of Technology and Health (STH).
Department 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 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.

Place, publisher, year, edition, pages
2008. Vol. 23, no 4, 1355-1361 p.
Keyword [en]
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
URN: urn:nbn:se:kth:diva-17413DOI: 10.1093/ndt/gfm805ISI: 000254472400044PubMedID: 18048421ScopusID: 2-s2.0-42949156922OAI: diva2:335457
QC 20100525Available from: 2010-08-05 Created: 2010-08-05 Last updated: 2012-02-15Bibliographically 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.
Trita-STH : report, ISSN 1653-3836 ; 2008:3
Cardiac, Kidney, Tissue, Velocity
National Category
Medical and Health Sciences
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
QC 20100809Available from: 2008-05-07 Created: 2008-05-07 Last updated: 2010-08-09Bibliographically approved

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