title: [Doppler tissue imaging contribution in the study of diastolic dysfunction in hemodialysis patients].
abstract: BACKGROUND
  Doppler echocardiography is currently the main tool permitting the diagnosis and the characterization of the stages of diastolic dysfunction.
  
  
  OBJECTIVE
  The purpose of this study is to precise the contribution of Doppler tissue imaging in the study of diastolic function and to identify the parameters having the most discriminating power of diastolic dysfunction in hemodialysis patients.
  
  
  METHODS
  Conventional Doppler echocardiography study implies left ventricular diastolic function from: Doppler transmitral flow (E/A, isovolumic relaxation time (TRIV), deceleration of mitral E-wave time (TDE), duration of A wave), color M-mode flow propagation velocity (Vp); The study of pulmonary venous flow (S/D, Systolic fraction (FS) and duration of pulmonary venous A wave); The annulus Doppler Tissue Imaging (Ea/Aa, E and A waves durations, VTI of E and A); and finally combined indexes (ratio of peak E-wave velocity to Vp (E/Vp), difference in duration between pulmonary venous and mitral flow A wave (Ap-Am) and ratio of peak mitral and annulus E-wave velocities (E/Ea).
  
  
  RESULTS
  Left ventricular diastolic dysfunction is found in 88% of the 50 haemodialysis patients: abnormal relaxation pattern 56%, pseudo-normal pattern 28% and restrictive pattern 4%. The parameter Vp discriminates normal patterns. The parameters TRIV, S/D and FS characterise abnormal relaxation. Ea/Aa ratio characterises pseudo-normal pattern and E/A ratio restrictive pattern. Discriminating analysis allows a correct classification of 100% of pseudo-normal pattern patients with 3 variables: Ea/Aa, FS and Vp or E/Vp. Doppler parameters which discriminating power is significant (p < 0.0001) are, in decreasing order: E/A, Ea/Aa, TRIV, Vp, FS, S/D, E/Vp and TDE.
  
  
  CONCLUSIONS
  DTI contributes mainly in the characterization of stage II diastolic dysfunction patients and allows in association with pulmonary venous flow parameters (Ap-Am) and combined indexes (E/Vp et E/Ea) an accurate appreciation of left ventricular filling pressures.
authors.affiliation: Service De Cardiologie, Hopital De Menzel Bourguiba.
authors.forename: Ali
authors.initials: A
authors.lastname: Ben Khalfallah
authors.forename: Islem
authors.initials: I
authors.lastname: Sanaa
authors.forename: S
authors.initials: S
authors.lastname: Mokrani
authors.forename: Nizar
authors.initials: N
authors.lastname: Annabi
authors.forename: Lilia
authors.initials: L
authors.lastname: Ghodhbane
mesh_terms: D003971:Diastole / Q000502:physiology*; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology*