[Doppler echocardiographic study of left ventricular diastolic function in hemodialysis patients].
OBJECTIVE
The purpose of this study is to examine the diastolic dysfunction particularities in hemodialysis patients and to identify the parameters having the most discriminating power of diastolic dysfunction.


METHODS
Conventional Doppler echocardiography study implies left ventricular diastolic function from Doppler transmitral flow (E/A), color M-mode flow propagation velocity (Vp) and combined indexes: ratio of peak E-wave velocity to Vp (ENp) and difference in duration of pulmonary venous and mitral flow at atrial contraction (Ap-Am).


RESULTS
Left ventricular diastolic dysfunction is found in 86% of the 100 hemodialysis patients: abnormal relaxation pattern 52%, pseudo-normal pattern 21%, restrictive pattern 13%. Left ventricular hypertrophy is independent of blood pressure (eta2=3.386; p>0.06). Diastolic function pattern has no relation with duration of dialysis treatment (F=2.637, p>0.05) or left ventricular mass (F=4.298, p>0.06). We noted correlations with age for all parameters of transmitral Doppler flow (p<0.01), Vp and systolic fraction except combined indexes (p>0.05). Doppler parameters of which discriminating power is significant (p<0.001) are in deceasing order: isovolumic relaxation time, E/A, Vp, early filling deceleration time, Ap-Am, E/VP and systolic fraction. The parameter Vp discriminates normal filling from abnormal or pseudo-normal patterns. However it doesn't allow any discrimination between abnormal and pseudo-normal patterns or abnormal and restrictive patterns. Discriminating analysis classify correctly 100% of pseudo normal pattern patients with 2 variables (isovolumic relaxation time and Vp or VP with E/Vp). Factor analysis suggests that Vp characterizes normal pattern and E/A ratio and Ap-Am characterize restrictive pattern.


CONCLUSIONS
Parameters of diastolic function discriminating value is different from one stage to another. VP characterizes normal pattern, combined indexes restrictive pattern. Vp and isovolumic relaxation time discriminates normal from pseudo-normal pattern.
Ben Khalfallah
A
A
Service de cardiologie, hôpital De Menzel Bourguiba, Tunisie. benkhalfallah@planet.tn
Ghodhbane
L
L
Tlili
R
R
Annabi
N
N
D003937:Diagnosis, Differential; D003971:Diastole; D018618:Echocardiography, Doppler, Color; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012680:Sensitivity and Specificity