Myocardial Tissue Doppler Imaging Detects Right Ventricular Dysfunction after Percutaneous Angioplasty of Dysfunctional Hemodialysis Access in Uremic Patients.
BACKGROUND
Right ventricular dysfunction has been observed in uremic patients receiving percutaneous transluminal angioplasty (PTA). This prospective study focuses on the impact of tissue Doppler imaging echocardiographic parameters on assessing right ventricle function in uremic patients post PTA of dysfunctional hemodialysis access.


METHODS
Sixty uremic patients were divided into two groups by angiographic findings: an occlusive group (26 patients) and a stenotic group (34 patients). All uremic patients underwent routine echocardiography with tissue Doppler imaging both before and immediately following PTA to assess the right ventricular (RV) function and pulmonary artery systolic pressure (PASP). The right ventricular (RV) myocardial performance index (MPI) was obtained during tissue Doppler imaging over the lateral tricuspid annulus. The M index was measured and defined as the peak early diastolic mitral inflow velocity divided by the RV MPI. The RV MPI, RV isovolumic relaxation time (IVRT) and M-index were used to evaluate RV function post-PTA.


RESULTS
Immediately following PTA, PASP (31.6 ± 11.3 mmHg versus 42.6 ± 12.0 mmHg, p = 0.001), RV MPI (0.46 ± 0.08 versus 0.62 ± 0.13, p < 0.001) and IVRT (75.1 ± 12.9 versus 98.4 ± 27.7 ms, p < 0.001) increased significantly in the occlusive group. However, PASP and RV function did not change significantly in the stenotic group. In 42.3% patients from the occlusive group, the M-index fell below 112 and RV MPI rose above 0.55 post-PTA; this occurred in only 8.8% of the stenotic group.


CONCLUSIONS
This prospective study demonstrated that there was a higher incidence of RV dysfunction in uremic patients with elevated PASP with totally occluded hemodialysis access than those with stenotic access post-PTA.


BACKGROUND
Myocardial performance index; Percutaneous transluminal angioplasty; Pulmonary hypertension; Tissue Doppler image; Uremic.
Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan;
Feng-Yu
FY
Kuo
Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; ; School of Medicine, National Yang-Ming University, Taipei, Taiwan; ; Department of Physical Therapy, Fooyin University, Kaohsiung City, Taiwan;
Wei-Chun
WC
Huang
Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; ; School of Medicine, National Yang-Ming University, Taipei, Taiwan;
Kuan-Rau
KR
Chiou
Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; ; School of Medicine, National Yang-Ming University, Taipei, Taiwan;
Shih-Hung
SH
Hsiao
Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan;
Shih-Kai
SK
Lin
Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; ; School of Medicine, National Yang-Ming University, Taipei, Taiwan;
Chi-Cheng
CC
Lai
Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan;
Tong-Chen
TC
Yeh
Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan;
Tao-Yu
TY
Lee
Department of Physical Therapy, Fooyin University, Kaohsiung City, Taiwan;
Jin-Shiou
JS
Yang
Cheng Shiu University, Kaohsiung City, Taiwan.
Tzu-Wen
TW
Lin
Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan;
Guang-Yuan
GY
Mar
Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; ; School of Medicine, National Yang-Ming University, Taipei, Taiwan;
Shoa-Lin
SL
Lin
Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; ; School of Medicine, National Yang-Ming University, Taipei, Taiwan;
Chun-Peng
CP
Liu