title: Relation between right and left ventricular function in patients undergoing chronic dialysis.
abstract: OBJECTIVE
  Occurrence of heart failure during dialysis treatment is associated with high mortality. However, mechanisms underlying left ventricular dysfunction (LVD) in these patients are still elusive. In patients undergoing haemodialysis, arteriovenous fistula (AVF) is associated with right ventricular dysfunction (RVD) and a further impairment is observed when AVF is brachial rather than radial. However, it is not known whether AVF-induced RVD is associated with an impaired left ventricular function. We studied the relation between right and left ventricular function in 120 patients undergoing either haemodialysis or peritoneal dialysis and 100 healthy age-matched controls.
  
  
  METHODS
  Echocardiography including tissue Doppler imaging (TDI) was performed for both ventricles. Average myocardial performance index (MPI) of the right ventricle (RV MPI) was obtained with a multisegmental approach by using TDI.
  
  
  RESULTS
  RVD was higher in haemodialysis than peritoneal dialysis patients and a further increase was observed in haemodialysis patients with brachial access. Interestingly, RV MPI inversely correlated with indices of both left ventricular contraction and relaxation and the association was even stronger in haemodialysis patients, particularly in those with brachial AVF. Of note, dialysis patients in the upper tertile of RV MPI showed the larger impairment of left ventricular function. Regression analyses showed that RV MPI was independently associated with reduced left ventricular function. By contrast, LVD did not significantly affect right ventricular performance in this setting.
  
  
  CONCLUSIONS
  AVF-induced RVD may contribute to LVD in dialysis patients. AVF plays a pivotal role in triggering LVD via right-to-left ventricular interdependence.
authors.affiliation: Division of Cardiology, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, University of Rome 'Sapienza', Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Paneni
authors.forename: Mario
authors.initials: M
authors.lastname: Gregori
authors.forename: Giuseppino M
authors.initials: GM
authors.lastname: Ciavarella
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Sciarretta
authors.forename: Francesca
authors.initials: F
authors.lastname: Palano
authors.forename: Giulia
authors.initials: G
authors.lastname: Pignatelli
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Castello
authors.forename: Alessandro
authors.initials: A
authors.lastname: Domenici
authors.forename: Giorgio
authors.initials: G
authors.lastname: Punzo
authors.forename: Giuliano
authors.initials: G
authors.lastname: Tocci
authors.forename: Luciano
authors.initials: L
authors.lastname: De Biase
authors.forename: Paolo
authors.initials: P
authors.lastname: Menè
authors.forename: Massimo
authors.initials: M
authors.lastname: Volpe
mesh_terms: D000328:Adult; D000368:Aged; D001163:Arteriovenous Anastomosis; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects; D006435:Renal Dialysis / Q000009:adverse effects*; D013318:Stroke Volume / Q000502:physiology; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology