Fractional shortening/end-systolic stress correlation in the evaluation of left ventricular contractility in patients treated by acetate dialysis and lactate haemofiltration.
Fractional shortening/end-systolic stress (FS/ESS) correlation by echocardiography is a reliable index of left ventricular function. Acetate infusion or preload reduction due to water compartment re-equilibrium may induce ventricular derangements during dialytic treatment. In 13 patients on lactate haemofiltration (LHF) (mean age 56.8 +/- 11.9 years on regular dialytic treatment (RDT) for 75.3 +/- 56.5 months) and in seven patients on acetate haemodialysis (AHD) (mean age 48 +/- 10.7 years; on RDT for 43.9 +/- 49.2 months) fractional shortening/end-systolic stress was evaluated before and after single dialytic session. The following biochemical parameters were also studied: haematocrit (Htc), plasmatic osmolarity, ionised Ca, Na, K, and blood gases. In both groups the mean fractional shortening/end-systolic stress correlation maintained the same correlation coefficient before and after treatment (r = -0.68, P less than 0.001). Lactate haemofiltration and acetate haemodialysis by reducing the volume expansion and preload (mean interdialytic body-weight increase 2.5 +/- 0.8 kg in our patients), may decrease left ventricular contractility (Starling's law). Furthermore, acetate was postulated as a myocardial depressant. Dialysis-induced myocardial contractility variations plotted against fractional shortening/end-systolic stress correlation allowed the division of our patients into four different groups: (1) patients with increased fractional shortening and reduced end-systolic stress; (2) patients with unchanged fractional shortening and reduced end-systolic stress; (3) patients with reduced fractional shortening and increased end-systolic stress; and (4) patients with reduced fractional shortening and unchanged or reduced end-systolic stress. These groups include patients treated with either lactate haemofiltration or acetate haemodialysis. Our data cannot confirm the postulated acetate myocardial depressant activity.(ABSTRACT TRUNCATED AT 250 WORDS)
DiBello
V
V
Medical Clinic II Institute, University of Pisa, Italy.
Bianchi
A M
AM
Caputo
M T
MT
Santoro
G
G
Panichi
V
V
Parrini
M
M
Giusti
C
C
Palla
R
R
D000085:Acetates; D019342:Acetic Acid; D000328:Adult; D000368:Aged; D005260:Female; D006440:Hemofiltration / Q000009:adverse effects*; D006801:Humans; D007773:Lactates; D019344:Lactic Acid; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D006435:Renal Dialysis / Q000009:adverse effects*; D016277:Ventricular Function, Left
D000085:Acetates; D007773:Lactates; D019344:Lactic Acid; D019342:Acetic Acid