title: Diagnosis of left ventricular diastolic dysfunction in the setting of acute changes in loading conditions.
abstract: BACKGROUND
  Conventional pulsed wave Doppler parameters are known to be preload dependent, whereas newly proposed Doppler indices may be less influenced by variations in loading conditions. The aim of the present study was to evaluate the effects of haemodialysis-induced preload reduction on both conventional and new Doppler parameters for the assessment of left ventricular (LV) diastolic function.
  
  
  METHODS
  This prospective observational study was conducted in a medical-surgical intensive care unit (ICU) and nephrology department of a teaching hospital. In total, 37 haemodialysis patients with end-stage renal disease (age [mean +/- standard deviation]: 52 +/- 13 years) and eight ventilated ICU patients with acute renal failure receiving vasopressor therapy (age 57 +/- 16 years; Simplified Acute Physiology Score II 51 +/- 17) were studied. Echocardiography was performed before and after haemodialysis. Conventional pulsed wave Doppler indices of LV diastolic function as well as new Doppler indices, including Doppler tissue imaging early diastolic velocities (E' wave) of the septal and lateral portions of the mitral annulus, and propagation velocity of LV inflow at early diastole (Vp) were measured and compared before and after ultrafiltration.
  
  
  RESULTS
  The volume of ultrafiltration was greater in haemodialysis patients than in ICU patients (3.0 +/- 1.1 l versus 1.9 +/- 0.9 l; P = 0.005). All conventional pulsed wave Doppler parameters were altered by haemodialysis. In haemodialysis patients, E' velocity decreased after ultrafiltration when measured at the septal mitral annulus (7.1 +/- 2.5 cm/s versus 5.9 +/- 1.7 cm/s; P = 0.0003), but not at its lateral portion (8.9 +/- 3.1 cm/s versus 8.3 +/- 2.6 cm/s; P = 0.37), whereas no significant variation was observed in ICU patients. Vp decreased uniformly after ultrafiltration, the difference being significant only in haemodialysis patients (45 +/- 11 cm/s versus 41 +/- 13 cm/s; P = 0.04). Although of less magnitude, ultrafiltration-induced variations in Doppler parameters were also observed in haemodialysis patients with altered LV systolic function.
  
  
  CONCLUSIONS
  In contrast to other Doppler parameters, Doppler tissue imaging E' maximal velocity measured at the lateral mitral annulus represents an index of LV diastolic function that is relatively insensitive to abrupt and marked preload reduction.
authors.affiliation: Medical-surgical Intensive Care Unit, Dupuytren Teaching Hospital, Avenue Martin Luther King, 87000 Limoges, France. philippe.vignon@unilim.fr
authors.forename: Philippe
authors.initials: P
authors.lastname: Vignon
authors.forename: Vincent
authors.initials: V
authors.lastname: Allot
authors.forename: Jérôme
authors.initials: J
authors.lastname: Lesage
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Martaillé
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Aldigier
authors.forename: Bruno
authors.initials: B
authors.lastname: François
authors.forename: Hervé
authors.initials: H
authors.lastname: Gastinne
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications / Q000628:therapy; D003971:Diastole; D015150:Echocardiography, Doppler; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging; D015588:Observer Variation; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods*; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000209:etiology