Effects of hemodialysis on the cardiovascular system: quantitative analysis using wave intensity wall analysis and tissue velocity imaging.
Cardiovascular disease is the leading cause of death in patients with end-stage renal disease (ESRD). The aim of this study was to investigate the changes in cardiovascular function induced by a single session of hemodialysis (HD) by the analysis of cardiovascular dynamics using wave intensity wall analysis (WIWA) and of systolic and diastolic myocardial function using tissue velocity imaging (TVI). Gray-scale cine loops of the left common carotid artery, conventional echocardiography, and TVI images of the left ventricle were acquired before and after HD in 45 patients (17 women, mean age 54 years) with ESRD. The WIWA indexes, W(1) and preload-adjusted W(1), W(2) and preload-adjusted W(2), and the TVI variables, isovolumic contraction velocity (IVCV), isovolumic contraction time (IVCT), peak systolic velocity (PSV), displacement, isovolumic relaxation velocity (IVRV), isovolumic relaxation time (IVRT), peak early diastolic velocity (E'), and peak late diastolic velocity (A'), were compared before and after HD. The WIWA measurements showed significant increases in W(1) (P < 0.05) and preload-adjusted W(1) (P < 0.01) after HD. W(2) was significantly decreased (P < 0.05) after HD, whereas the change in preload-adjusted W(2) was not significant. Systolic velocities, IVCV (P < 0.001) and PSV (P < 0.01), were increased after HD, whereas the AV-plane displacement was decreased (P < 0.01). For the measured diastolic variables, E' was significantly decreased (P < 0.01) and IVRT was significantly prolonged (P < 0.05), after HD. A few correlations were found between WIWA and TVI variables. The WIWA and TVI measurements indicate that a single session of HD improves systolic function. The load dependency of the diastolic variables seems to be more pronounced than for the systolic variables. Preload-adjusted wave intensity indexes may contribute in the assessment of true LV contractility and relaxation.
Department of Medical Engineering, School of Technology and Health, Royal Institute of Technology (KTH), Alfred Nobels Allé 10, Huddinge, 141 52, Stockholm, Sweden. anna.bjallmark@sth.kth.se
Anna
A
Bjällmark
Matilda
M
Larsson
Jacek
J
Nowak
Britta
B
Lind
Shirley Yumi
SY
Hayashi
Marcelo Mazza
MM
do Nascimento
Miguel C
MC
Riella
Astrid
A
Seeberger
Lars-Åke
LÅ
Brodin
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging / Q000503:physiopathology*; D003971:Diastole; D018618:Echocardiography, Doppler, Color; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D020127:Recovery of Function; D006435:Renal Dialysis; D013548:Sweden; D013599:Systole; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D055815:Young Adult