NDT Advance Access published online on June 13, 2008
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfn311
A single session of haemodialysis improves left ventricular synchronicity in patients with end-stage renal disease: a pilot tissue synchronization imaging study
1 Department of Medical Engineering, School of Technology and Health, Royal Institute of Technology 2 Department of Laboratory Medicine, Division of Clinical Physiology 3 Division of Renal Medicine and Division of Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital in Huddinge, Stockholm, Sweden
Correspondence and offprint requests to: Shirley Yumi Hayashi, Division of Renal Medicine, Karolinska Institutet, Karolinska University Hospital in Huddinge, S-141 86 Stockholm, Sweden. E-mail: shirley.yumi.hayashi{at}ki.se
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Abstract |
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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.
Keywords: end-stage renal disease; haemodialysis; left ventricular hypertrophy; systolic dyssynchrony; tissue synchronization imaging
Received for publication: 27. 9.07
Accepted in revised form: 7. 5.08