Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
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Advances in Clinical and Experimental Medicine

2010, vol. 19, nr 4, July-August, p. 469–480

Publication type: original article

Language: English

Factors Influencing the Tissue Doppler Echocardiography Indices of Systolic and Diastolic Function of Left Myocardial Ventricle in Patients Treated with Intermittent Hemodialysis

Czynniki wpływające na wskaźniki tkankowej echokardiografii dopplerowskiej funkcji skurczowej i rozkurczowej mięśnia sercowego lewej komory u chorych leczonych powtarzaną hemodializą

Alicja E. Grzegorzewska1,, Aniela Ratajewska2,, Agnieszka Wiesiołowska3,

1 Chair and Department of Nephrology, Transplantology and Internal Diseases, Karol Marcinkowski University of Medical Sciences, Poznań, Poland

2 Outpatient Cardiology Clinic, International Dialysis Center, Rawicz, Poland

3 Chair and Department of Computer Science and Statistics; Karol Marcinkowski University of Medical Sciences, Poznań, P

Abstract

Background. Uremic toxicity and overhydration are cardiovascular risk factors, which are significantly, although transiently, decreased by each hemodialysis (HD) session.
Objectives. Evaluation of tissue Doppler echocardiography (echo) indices estimating function of left myocardial ventricle before and after HD session with relation to demographic, clinical and laboratory parameters of examined patients.
Material and Methods. The 56 patients underwent tissue Doppler echo before and after 4-hour HD with ultrafiltration volume (UFV) depended on difference between actual and dry body mass. Preand post-HD echo indices and their differences were related to demographic, clinical and laboratory data.
Results. Pre-HD echo indices revealed systolic dysfunction (LVEF < 50%) in 12.5% patients, diastolic dysfunction – in 92.9% patients (mild in 39.3%, moderate in 46.4%, severe in 7.1%). After HD session (UFV 2.1 ± 1.0 L, Kt/V 1.33 ± 0.14) systolic dysfunction was shown in 10.7% patients, diastolic dysfunction – in 92.9% (mild in 60.7%, moderate in 26.8%, severe in 5.4%). Preand post-HD echo indices correlated with age, HD vintage, Hb/ Hct/RBC, CRP and PTH. Differences in preand post-HD echo parameters correlated with UFV, Hb/Hct/RBC, WBC, Ca, P, Ca x P, uric acid, and daily urine volume. Independent predictors of echo parameters were age, ischemic heart disease, valvular disease, treatment with ACEI/ARB and/or β-blockers, UFV and CRP.
Conclusion. In HD patients echo indices and beneficial effects of HD-induced decrease in preload on echo indices are negatively related to anemia, inflammation, decreased renal function, ischemic heart disease and valvular disease.

Streszczenie

Wprowadzenie. Toksemia mocznicowa i przewodnienie są czynnikami ryzyka chorób sercowo-naczyniowych, które znacząco, chociaż przejściowo, zmniejszają się podczas każdego zabiegu hemodializy (HD).
Cel pracy. Ocena wskaźników tkankowej echokardiografii (echo) dopplerowskiej szacujących czynność mięśnia sercowego lewej komory przed i po zabiegu HD w odniesieniu do parametrów demograficznych, klinicznych i laboratoryjnych badanych chorych.
Materiał i metody. U 56 chorych wykonano echo z Dopplerem tkankowym przed i po 4-godzinnej HD z objętością ultrafiltracji (UFV) zależną od różnicy między bieżącą a suchą masą ciała. Wskaźniki echo, uzyskane przed i po HD, oraz różnice między nimi odniesiono do danych demograficznych, klinicznych i laboratoryjnych.
Wyniki. Przeddializacyjne parametry echo wskazywały na dysfunkcję skurczową (LVEF < 50%) u 12,5% chorych, a dysfunkcję rozkurczową – u 92,9% chorych (łagodną u 39,3%, umiarkowaną u 46,4%, ciężką u 7,1%). Po zabiegu HD (UFV 2,1 ± 1,0 l, Kt/V 1,33 ± 0,14) dysfunkcja skurczowa występowała u 10,7% chorych, a dysfunkcja rozkurczowa – u 92,9% (łagodna u 60,7%, umiarkowana u 26,8%, ciężka u 5,4%). Przedi podializacyjne wskaźniki echo korelowały z wiekiem, długością leczenia HD, Hb/Hct/RBC, CRP i PTH. Różnice między wskaźnikami przed i po HD korelowały z UFV, Hb/Hct/RBC, WBC, Ca, P, Ca x P, kwasem moczowym i dobową objętością moczu. Niezależnymi predyktorami wskaźników echo były wiek, choroba niedokrwienna serca, choroba zastawek, leczenie ACEI/ARB i/lub lekami blokującymi kanał β, UFV i CRP.
Wnioski. U chorych leczonych HD zarówno wskaźniki echo, jak i dobroczynny wpływ obniżonego w wyniku zabiegu HD obciążenia wstępnego na te wskaźniki, podlegają niekorzystnym oddziaływaniom niedokrwistości, zapalenia, upośledzonej czynności nerek, niedokrwiennej choroby serca i choroby zastawek serca.

Key words

tissue Doppler echocardiography, left ventricular function, hemodialysis, uremic toxicity

Słowa kluczowe

tkankowa echokardiografia dopplerowska, czynność mięśnia sercowego lewej komory, hemodializa, toksemia mocznicowa

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