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Oktan MA, Korucu B, Çolak A, Bildacı YD, Çavdar C, Değer SM. The relationship between changes in peritoneal membrane solute transfer characteristics and cardiac remodeling in patients with peritoneal dialysis. Ther Apher Dial 2024. [PMID: 38837848 DOI: 10.1111/1744-9987.14170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 04/20/2024] [Accepted: 05/15/2024] [Indexed: 06/07/2024]
Abstract
INTRODUCTION We aimed to determine the relationship between the dilatation of the heart chambers and the change in peritoneal membrane solute transfer characteristics (PMTC) in long-term peritoneal dialysis (PD) patients. METHODS This is a retrospective, single-center study including the follow-up of maintenance PD patients. According to the changes in PMTC from baseline to the last visit, patients were divided into three groups; stable (n = 11), increased (n = 41), and decreased transporters (n = 35). RESULTS Left atrium (LA) and Right ventricle (RV) dilatation were more prominent in the PMTC-decreased group compared to PMTC-increased and stable groups (p < 0.001 and p = 0.07, respectively). The Cox regression analysis showed that only decreased PMTC was associated with LA dilatation (HR 2.89 [CI 95%1.54, 5.45] p < 0.01) and RV dilatation (HR 3.01 [CI 95%1.40, 6.21] p < 0.01). CONCLUSION PD can be associated with unfavorable dynamic changes in cardiac structure and functions even at the subclinical level.
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Affiliation(s)
- Mehmet Ası Oktan
- Dokuz Eylul University Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Izmir, Turkey
| | - Berfu Korucu
- Dokuz Eylul University Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Izmir, Turkey
| | - Ayşe Çolak
- Department of Cardiology, Dokuz Eylül University School of Medicine, Izmir, Turkey
| | - Yelda Deligöz Bildacı
- Dokuz Eylul University Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Izmir, Turkey
| | - Caner Çavdar
- Dokuz Eylul University Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Izmir, Turkey
| | - Serpil Müge Değer
- Dokuz Eylul University Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Izmir, Turkey
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Hong J, Zhang Y, Wang Y, Zhang T, Wang X, Xu D. Influence of a single hemodialysis on left ventricular energy loss and wall shear stress in patients with uremic cardiomyopathy assessed with vector flow mapping. Quant Imaging Med Surg 2022; 12:4059-4068. [PMID: 35919051 PMCID: PMC9338362 DOI: 10.21037/qims-21-1083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 05/30/2022] [Indexed: 11/06/2022]
Abstract
Background The influence of hemodialysis (HD) on hydromechanics of the left ventricle has not been reported. This study evaluated the left ventricular summation of energy loss (EL-SUM), average energy loss (EL-AVE), and wall shear stress (WSS) before and after HD using vector flow mapping (VFM) in patients with end-stage renal disease (ESRD). Methods We prospectively recruited 40 patients receiving long-term HD and excluded those with structural cardiac disease. Echocardiography was performed before and within 24 hours after HD. Conventional echocardiographic parameters, summation, and average energy loss (EL-SUM, EL-AVE, EL-base, EL-mid and EL-apex), and WSS in each segment were compared. Results A total of 40 patients with uremia were recruited. After HD, left ventricular EL-AVE-total, and EL-SUM-total decreased significantly in the early diastolic [29.43 (18.76 to 46.28) vs. 17.70 (10.76 to 95.60) N/(m2·s) and 12 (6 to 17) vs. 5 (3 to 11) e−2 J; P<0.001, respectively], mid-diastolic [17.07 (10.38 to 24.35) vs. 10.29 (5.86 to 16.30) N/(m2·s) and 7 (3 to 10) vs. 4 (2 to 6) e−2 J; P<0.001, respectively], and early systolic [17.82 (12.79 to 24.77) vs.14.90 (10.23 to 19.05) N/(m2·s) P=0.011 and 8 (5 to 11) vs. 5 (4 to 8) e−2 J, P=0.002, respectively] phases. It was revealed that HD did not change EL-AVE-total and EL-SUM-total in the late diastolic and late systolic phases. The EL-AVE decreased after HD in the left ventricular (LV) basal [50.70 (24.19 to 77.92) vs. 26.00 (11.50 to 47.68) N/(m2·s); P<0.001] and mid [15.52 (8.88 to 20.90) vs. 9.47 (6.41 to 14.21) N/(m2·s); P=0.001] segments during the early diastolic phase; in the LV basal [18.64 (10.33 to 29.80) vs. 10.25 (6.98 to 19.43) N/(m2·s); P<0.001), mid (15.70 (9.93 to 23.08) vs. 9.99 (6.03 to 16.25) N/(m2·s); P<0.001), and apical [9.78 (4.06 to 15.77) vs. 4.52 (3.14 to 10.36) N/(m2·s); P=0.001) segments during the mid-diastolic phase; in the LV mid [14.34 (8.34 to 23.88) vs. 9.36 (6.48 to 17.05) N/(m2·s); P=0.013] and apex [11.25 (6.37 to 21.88) vs. 6.60 (5.33 to 12.17) N/(m2·s); P=0.016] segments during the late diastolic phase; and in the apical [10.28 (6.05 to 17.01) vs. 7.59 (3.73 to 13.20) N/(m2·s) P=0.025] segment during the early systolic phase. After HD, WSS significantly reduced in the mid-diastolic [0.51 (0.32 to 0.69) vs. 0.38 (0.30 to 0.46) Pa, P=0.001] and early systolic [0.60 (0.45 to 0.81) vs. 0.57 (0.42 to 0.68) Pa, P=0.029] phases. There was no change in WSS during the early diastolic, late diastolic, and late systolic phases. Conclusions After HD, EL and WSS of LV decrease during the systolic and diastolic phases. The VFM can reflect the LV hemodynamics in patients undergoing HD under different fluid loads.
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Affiliation(s)
- Jian Hong
- Department of Geriatrics, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yanjuan Zhang
- Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yingying Wang
- Department of Geriatrics, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Tao Zhang
- Department of Geriatrics, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaoyan Wang
- Department of Geriatrics, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Di Xu
- Department of Geriatrics, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Ünlü S, Bézy S, Cvijic M, Duchenne J, Delcroix M, Voigt JU. Right ventricular strain related to pulmonary artery pressure predicts clinical outcome in patients with pulmonary arterial hypertension. Eur Heart J Cardiovasc Imaging 2022; 24:635-642. [PMID: 35852912 DOI: 10.1093/ehjci/jeac136] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/29/2022] [Indexed: 12/18/2022] Open
Abstract
Abstract
Aims
In pulmonary arterial hypertension (PAH), the right ventricle (RV) is exposed to an increased afterload. In response, RV mechanics are altered. Markers which would relate RV function and afterload could therefore aid to understand this complex response system and could be of prognostic value. The aim of our study was to (i) assess the RV-arterial coupling using ratio between RV strain and systolic pulmonary artery pressure (sPAP), in patients with PAH, and (ii) investigate the prognostic value of this new parameter over other echocardiographic parameters.
Methods and results
Echocardiograms of 65 pre-capillary PAH patients (45 females, age 61 ± 15 years) were retrospectively analysed. Fractional area change (FAC), sPAP, tricuspid annular plane systolic excursion, and RV free-wall (FW) longitudinal strain (LS) were measured. A primary endpoint of death or heart/lung transplantation described clinical endpoint. Patients who reached a clinical endpoint had worse functional capacity (New York Heart Association), reduced RV function, and higher sPAP. Left ventricle function was similar in both groups. Only RVFW LS/sPAP ratio was found as an independent predictor of clinical endpoint in multivariable analysis (hazard ratio 8.3, 95% confidence interval 3.2–21.6, P < 0.001). The RWFW LS/sPAP (cut-off 0.19) demonstrated a good accuracy for the prediction of reaching the clinical endpoint, with a sensitivity of 92% and specificity of 82.5%.
Conclusion
RVFW LS/sPAP ratio significantly predicts all-cause mortality and heart–lung transplantation, and was superior to other well-established parameters, in patients with pre-capillary PAH. We therefore propose RVFW LS/sPAP as a new prognostic echocardiographic marker.
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Affiliation(s)
- Serkan Ünlü
- Department of Cardiovascular Diseases, University Hospitals Leuven , Herestraat 49, 3000 Leuven , Belgium
- Department of Cardiology, Gazi University Faculty of Medicine , Ankara , Turkey
| | - Stéphanie Bézy
- Department of Cardiovascular Diseases, University Hospitals Leuven , Herestraat 49, 3000 Leuven , Belgium
| | - Marta Cvijic
- Department of Cardiovascular Diseases, University Hospitals Leuven , Herestraat 49, 3000 Leuven , Belgium
- Department of Cardiology, University Medical Centre Ljubljana, Slovenia Faculty of Medicine, University of Ljubljana , Ljubljana , Slovenia
| | - Jürgen Duchenne
- Department of Cardiovascular Diseases, University Hospitals Leuven , Herestraat 49, 3000 Leuven , Belgium
| | - Marion Delcroix
- Department of Pulmonology, University Hospitals Leuven , Leuven , Belgium
| | - Jens Uwe Voigt
- Department of Cardiovascular Diseases, University Hospitals Leuven , Herestraat 49, 3000 Leuven , Belgium
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Hosseinsabet A, Mahmoudian R, Jalali A, Mohseni-Badalabadi R, Davarpasand T. Normal Ranges of Right Atrial Strain and Strain Rate by Two-Dimensional Speckle-Tracking Echocardiography: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2022; 8:771647. [PMID: 34977185 PMCID: PMC8718502 DOI: 10.3389/fcvm.2021.771647] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/24/2021] [Indexed: 01/31/2023] Open
Abstract
Background: Normal range values of right atrial (RA) phasic function markers are essential for the identification of normal and abnormal values, comparison with reference values, and the clinical meaning of obtained values. Accordingly, we aimed to define the normal range values of RA phasic function markers obtained by 2D speckle-tracking echocardiography through a meta-analysis and determine the main sources of heterogeneity among reported values. Methods: PUBMED, SCOPUS, and EMBASE databases were searched for the following keywords: "right atrial/right atrium" and "strain/speckle/deformation" and "echocardiography." Studies were selected that included a human healthy adult group without any cardiovascular diseases or risk factors and that were written in the English language. For the calculation of each marker of RA phasic functions, a random-effect model was used. Meta-regression was employed to define the major sources of variabilities among reported values. Results: Fifteen studies that included 2,469 healthy subjects were selected for analysis. The normal range values for RA strain and strain rate were 42.7% (95% CI, 39.4 to 45.9%) and 2.1 s-1 (95% CI, 2.0 to 2.1 s-1) during the reservoir phase, respectively, 23.6% (95% CI, 20.7 to 26.6%) and -1.9 s-1 (95% CI, -2.2 to -1.7 s-1) during the conduit phase, correspondingly, and 16.1% (95% CI, 13.6 to 18.6%) and -1.8 s-1 (95% CI, -2.0 to -1.5 s-1) during the contraction phase, respectively. The sources of heterogeneity for the normal range of these markers were the number of participants, the type of software, the method of global value calculation, the right ventricular fractional area change, the left ventricular (LV) ejection fraction, the RA volume index, sex, the heart rate, the diastolic blood pressure, the body mass index, and the body surface area. Conclusions: Using 2D speckle-tracking echocardiography, we defined normal values for RA phasic function markers and identified the sources of heterogeneity as demographic, anthropometric, hemodynamic, and echocardiography factors. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021236578, identifier: CRD42021236578.
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Affiliation(s)
- Ali Hosseinsabet
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Roshanak Mahmoudian
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Jalali
- Department of Research, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Mohseni-Badalabadi
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Tahereh Davarpasand
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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Tanasa A, Burlacu A, Popa IV, Covic A. Right Ventricular Functionality Following Hemodialysis Initiation in End-Stage Kidney Disease-A Single-Center, Prospective, Cohort Study. ACTA ACUST UNITED AC 2021; 57:medicina57070704. [PMID: 34356985 PMCID: PMC8307593 DOI: 10.3390/medicina57070704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/02/2021] [Accepted: 07/09/2021] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Two-dimensional speckle tracking echocardiography (2D-STE) is viewed as an outstanding technique, competent of uncovering earlier subclinical myocardial anomalies compared to conventional echocardiography. A few endeavors adopted 2D-STE as a tool to estimate right ventricular (RV) function in subjects with end-stage kidney disease (ESKD). There is no published prospective study on an adult ESKD cohort exploring the consequences of commencing elective hemodialysis (HD) on RV behavior. Materials and Methods: We investigated the RV systolic function using traditional (tricuspid annular plane systolic excursion-TAPSE, RV fractional area change-FAC) and 2D-STE (RV free wall longitudinal strain-RVFWLS) parameters following the initiation of HD. We enrolled 79 consecutive patients with ESKD and assessed them in four steps-at baseline, before HD, and at 3, 6, and 12 months. Results: RVFWLS, FAC, and TAPSE values had a significant increase at 3, 6, and 12 months from baseline (p < 0.001) and a significant increase at 6 months from 3 months (p < 0.001). However, differences between 12 months and 6 months were not significant (p > 0.05) according to Dunn-Bonferroni post hoc tests. Seventeen deaths were recorded before the completion of the study. RVFWLS, FAC, and TAPSE values significantly decreased at 3 and 6 months in all 17 deceased patients, in clear opposition with the values survivors had. All the studied parameters had a significant prediction power on mortality (p < 0.001) having an outstanding performance: baseline-RVFWLS (AUC: 1.000 (95% C.I.: 1.000-1.000)), baseline-FAC (AUC: 0.974 (95% C.I.: 0.942-1.000)), and baseline-TAPSE (AUC: 0.962 (95% C.I.: 0.920-1.000). Conclusions: Our study is the first to investigate RV function by 2D-STE and correlate it with traditional methods in patients with ESKD before and after the initiation of HD. RV function was significantly ameliorated at 3, 6, and 12 months compared to the pre-HD values. FAC and RVFWLS gain an outstanding prognostic role on mortality in this population.
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Affiliation(s)
- Ana Tanasa
- Nephrology Clinic, Dialysis, Renal Transplant Center—‘C.I. Parhon’ University Hospital, 700503 Iasi, Romania; (A.T.); (A.C.)
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania
| | - Alexandru Burlacu
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania
- Institute of Cardiovascular Diseases “Prof. Dr. George I.M. Georgescu”, 700503 Iasi, Romania
- Correspondence: (A.B.); (I.V.P.); Tel.: +40-744488580 (A.B.); +40-723651930 (I.V.P.)
| | - Iolanda Valentina Popa
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania
- Correspondence: (A.B.); (I.V.P.); Tel.: +40-744488580 (A.B.); +40-723651930 (I.V.P.)
| | - Adrian Covic
- Nephrology Clinic, Dialysis, Renal Transplant Center—‘C.I. Parhon’ University Hospital, 700503 Iasi, Romania; (A.T.); (A.C.)
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania
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Ünlü S, Yamak BA, Sezenöz B, Şahinarslan A, Arınsoy ST. Left atrial contractile longitudinal strain determines intrinsic left atrial function regardless of load status and left ventricular deformation. Int J Cardiovasc Imaging 2021; 37:3245-3253. [PMID: 34176030 DOI: 10.1007/s10554-021-02324-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 06/21/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Left atrial (LA) longitudinal strain (S) has been proposed as a superior, non-invasive parameter over LA volumetric assessment. LAS has diagnostic and prognostic value in many cardiovascular pathologies. Nevertheless, the acute effect of hemodynamic changes on LAS indices is not well-established. We sought to identify volume independent physiomechanical changes in LA and interrelation between LA and left ventricular (LV) strain indices following a large amount of fluid loss provided by hemodialysis. METHODS Seventy-five patients between 18 and 85 years of age under hemodialysis therapy were included. The echocardiographic images were obtained before and after hemodialysis. Phasic LAS and LV global longitudinal strain (GLS) were calculated. The impact of volume depletion on echocardiographic measurements and their temporal correlation were calculated. RESULTS LV and LA dimensions,volumes and LV, LA reservoir, and conduit deformation showed a significant decrease after hemodialysis. No significant change was observed for LAScontraction (p = 0.203). The ultrafiltrated volume was significantly correlated with the changes in LVGLS (r = 0.75, p < 0.001), and LASreservoir (r = 0.81, p < 0.001) and LA total emptying volume (r = 0.80, p < 0.001). Absolute changes in LASreservoir and LVGLS were strongly correlated (r = 0.83, p < 0.001). There was no correlation between absolute changes in LAScontraction and LVGLS or ultrafiltrated volume (p = NS, both). CONCLUSION LA reservoir and conduit LS are highly volume dependent strain parameters and are strongly correlated with LV deformation along with ultrafiltrated volume. Acute excessive volume depletion or LV deformation have no influence on LAScontraction. It is important to identify independent easily accessible functional parameters for the LA which would improve clinical evaluation.
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Affiliation(s)
- Serkan Ünlü
- Department of Cardiology, Faculty of Medicine, Gazi University, Ankara, Turkey.
| | - Betül Ayça Yamak
- Department of Cardiology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Burak Sezenöz
- Department of Cardiology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Asife Şahinarslan
- Department of Cardiology, Faculty of Medicine, Gazi University, Ankara, Turkey
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Wang X, Hong J, Zhang T, Xu D. Changes in left ventricular and atrial mechanics and function after dialysis in patients with end-stage renal disease. Quant Imaging Med Surg 2021; 11:1899-1908. [PMID: 33936973 DOI: 10.21037/qims-20-961] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background Hemodialysis (HD) can influence end-stage renal disease (ESRD) patients' circulatory system. The present study aimed to evaluate the effect of volume depletion on left ventricular (LV) and left atrial (LA) function and determine the volume-independent parameters before and after HD in patients with ESRD. Methods Between January 2018 and January 2019, we recruited long-term HD patients (n=40, 51.0±16.4 years), excluding those with structural cardiac disease. Echocardiographic parameters, including LV and LA volumes, flow Doppler, pulsed tissue Doppler, and speckle tracking echocardiography (STE) before and after HD (within 24 h), were examined, and the values were compared. Results Following HD, alteration in LV end-systolic volume was not detected, whereas LV end-diastolic volume (90.18±23.91 vs. 84.21±23.54 mL, P=0.036) and LV ejection fraction (LVEF; 64.63%±6.56% vs. 62.84%±6.56%, P=0.049) decreased. Peak early diastolic trans-mitral flow velocity (E-wave; 82.22±20.13 vs. 72.43±18.32 cm/s, P<0.001), peak early diastolic tissue Doppler velocity (e'; 6.45±1.88 vs. 5.77±1.63 cm/s, P<0.001) at the septal side of the mitral annulus, the ratio of early to late Doppler velocities of diastolic mitral inflow (0.90±0.27 vs. 0.79±0.23, P<0.001), and the average E/e' ratio (12.54±4.08 vs. 11.28±4.52, P=0.049) decreased significantly. No significant difference was found in peak blood flow velocity at the mitral valve during late diastole and e' at the lateral side of the mitral annulus after HD. LA volume index (35.55±12.61 vs. 30.22±9.80 mL/m2, P<0.001), tricuspid regurgitation velocity (260.11±36.54 vs. 242.37±32.22 cm/s, P=0.002), and pulmonary artery systolic pressure (33.63±11.29 vs. 29.94±7.80 mmHg, P=0.006) significantly decreased. LV global longitudinal systolic strain (GLS) of 4-chamber view (-24.37%±3.02% vs. -23.38%±3.33%, P=0.019), rather than global circumferential systolic strain, exhibited significant change after HD. Significant changes were also found in LV longitudinal early diastolic strain rate (LSRe; 1.17±0.25 vs. 1.05±0.24 s-1, P<0.001) and early diastolic global radial velocity (Ve; 2.62±0.59 vs. 2.25±0.67 cm/s, P=0.011) after HD, but not in other strain rates and global radial velocity measurements. LA maximal volume (35.55±12.61 vs. 30.22±9.80 mL/m2, P<0.001), LA total emptying fraction (54.19%±10.39% vs. 49.63%±11.05%, P=0.009), and LA passive emptying fraction (32.23%±12.86% vs. 26.81%±9.28%, P=0.004) decreased significantly after HD, while LA minimal volume, the volume at the onset of atrial systole, and LA active emptying fraction after HD were not significantly different. Conclusions Most indices of systolic (LVEF and GLS of 4-chamber view) and early diastolic function (E-wave, e', LSRe, global radial Ve, and LA passive emptying fraction) were preload dependent. Late diastolic indices, including LV late diastolic global longitudinal strain rate, late diastolic global radial velocity, and LA active emptying fraction, did not change with volume depletion.
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Affiliation(s)
- Xiaoyan Wang
- Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jian Hong
- Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Tao Zhang
- Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Di Xu
- Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Valerianova A, Malik J, Janeckova J, Kovarova L, Tuka V, Trachta P, Lachmanova J, Hladinova Z, Hruskova Z, Tesar V. Reduction of arteriovenous access blood flow leads to biventricular unloading in haemodialysis patients. Int J Cardiol 2021; 334:148-153. [PMID: 33895210 DOI: 10.1016/j.ijcard.2021.04.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 04/04/2021] [Accepted: 04/16/2021] [Indexed: 12/28/2022]
Abstract
AIMS Patients on chronic haemodialysis have a wide range of changes in cardiac function and structure, including left ventricular hypertrophy, dilation and diastolic dysfunction or pulmonary hypertension. All these changes were linked to increased mortality in previous studies. High-flow arteriovenous fistulas (AVF) are supposed to be a factor contributing to their development. This study investigated the early effect of surgical AVF blood flow (Qa) reduction on these changes in patients with or without heart failure changes. METHODS AND RESULTS Forty-two patients in chronic haemodialysis programme with high-flow AVF (Qa over 1500 mL/min), indicated for surgery for ≥1 of the following indications: 1.manifest heart failure; 2.hand ischemia; 3.advanced structural heart changes detected by echocardiography. The patients underwent echocardiography on selection visit, before blood flow reducing surgery and six weeks thereafter. The Qa reduction led to decrease of left ventricular mass (p = 0.02), end-diastolic volume (p = 0.008), end-diastolic diameter (p = 0.003) and left atrial volume (p = 0.0006). Diastolic function improved. Similarly, right ventricular diameter and right atrial volume decreased (p = 0.000001 and 0.00009, respectively) together with the decrease of estimated pulmonary artery systolic pressure. 81% of patients suffered from pulmonary hypertension prior to surgery, only 36% thereafter. CONCLUSION The surgical restriction of the hyperkinetic circulation leads to several improvements of heart structure and function, which was linked to higher mortality in other studies. The beneficial effect of Qa reduction is present even in patients without symptoms of heart failure. The contribution of AVF must be considered with structural or functional heart changes.
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Affiliation(s)
- Anna Valerianova
- 3(rd) Department of Internal Medicine, 1(st) Faculty of Medicine, Charles University, General University Hospital in Prague, U Nemocnice 1, 128 08 Prague, Czech Republic.
| | - Jan Malik
- 3(rd) Department of Internal Medicine, 1(st) Faculty of Medicine, Charles University, General University Hospital in Prague, U Nemocnice 1, 128 08 Prague, Czech Republic
| | - Jana Janeckova
- II. Department of Surgery, University Hospital in Olomouc, I.P. Pavlova 185/6, 779 00 Olomouc, Czech Republic
| | - Lucie Kovarova
- 3(rd) Department of Internal Medicine, 1(st) Faculty of Medicine, Charles University, General University Hospital in Prague, U Nemocnice 1, 128 08 Prague, Czech Republic
| | - Vladimir Tuka
- 3(rd) Department of Internal Medicine, 1(st) Faculty of Medicine, Charles University, General University Hospital in Prague, U Nemocnice 1, 128 08 Prague, Czech Republic
| | - Pavel Trachta
- 3(rd) Department of Internal Medicine, 1(st) Faculty of Medicine, Charles University, General University Hospital in Prague, U Nemocnice 1, 128 08 Prague, Czech Republic
| | - Jana Lachmanova
- Department of Nephrology, 1(st) Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 08 Prague, Czech Republic
| | - Zuzana Hladinova
- Department of Nephrology, 1(st) Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 08 Prague, Czech Republic
| | - Zdenka Hruskova
- Department of Nephrology, 1(st) Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 08 Prague, Czech Republic
| | - Vladimir Tesar
- Department of Nephrology, 1(st) Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 08 Prague, Czech Republic
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Morita T, Nakamura K, Osuga T, Takiguchi M. Repeatability, reproducibility, and reference intervals for indices of right atrial longitudinal strain derived from speckle-tracking echocardiography in healthy dogs. Am J Vet Res 2021; 82:274-279. [PMID: 33764827 DOI: 10.2460/ajvr.82.4.274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine repeatability, reproducibility, and reference intervals of indices of right atrial longitudinal strain (RALS) derived from speckle-tracking echocardiography (STE) in dogs without heart disease. ANIMALS 110 client-owned dogs and 10 laboratory Beagles. PROCEDURES To determine intraobserver within-day (repeatability) and interobserver (reproducibility) coefficients of variation, RALS during ventricular systole (ϵS), ventricular early diastole (ϵE), and atrial systole (ϵA), as derived with STE, were obtained by 2 investigators for 5 randomly selected client-owned dogs and analyzed by linear regression. Reference intervals were estimated from the results of all dogs. Correlations between RALS indices (ϵS, ϵE, and ϵA) and sex, age, body weight, heart rate, and blood pressure were determined. RESULTS RALS derived from STE showed good intraobserver within-day repeatability and interobserver reproducibility, with coefficients of variation of < 20%. Both ϵS and ϵE were significantly negatively correlated with age, but ϵA was not correlated with age. Indices were not correlated with sex, body weight, or blood pressure. CONCLUSIONS AND CLINICAL RELEVANCE RALS indices derived from STE were repeatable and reproducible and were affected by the age of dogs without heart disease. Age should be considered in the interpretation of RALS indices in clinical settings. Further studies are needed to apply RALS indices for assessing dogs with heart disease.
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Zhang Y, Ding XH, Pang F, Zhang L, Wang Y, Wang W, Rao R, Bian SZ. The Prevalence and Independent Risk Factors of Significant Tricuspid Regurgitation Jets in Maintenance Hemodialysis Patients With ESRD. Front Physiol 2021; 11:568812. [PMID: 33391009 PMCID: PMC7773604 DOI: 10.3389/fphys.2020.568812] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 11/30/2020] [Indexed: 01/19/2023] Open
Abstract
Background and Aim Tricuspid regurgitation (TR) is a frequent complication in various cardiovascular diseases. However, few studies have reported the prevalence of TR especially the moderate to severe or significant TR (ms-TR) maintenance dialysis patients. Thus, we aimed to identify the prevalence of ms-TR and its associated factors. Methods A total of 491 maintenance dialysis patients underwent echocardiographic examinations, while a subgroup (n = 283) also received routine blood tests, renal function examinations, and electrolyte analysis. We first compared the differences in abovementioned parameters among groups with various TR areas (TRAs). Finally, univariate and adjusted regression were also used to identify factors that were independently associated with ms-TR. Results The incidence of TR jets was 62.6%, which included a mildly increased TRA (47.8%), moderately increased TRA (10.4%), and severely increased TRA (3.5%). Most of the cardiac structures and functional parameters, such as the end-diastolic internal diameters of the left atrium (LA), left ventricle (LVDD), right atrium (RA), right ventricle (RV), left ventricular ejection fraction (LVEF), and fractional shortening (FS), were significantly associated with ms-TR. Among serum ions, only total CO2 (TCO2; r = −0.141, p = 0.047) was negatively correlated with TRA. After adjusted, only Na+ [odds ratio (OR): 0.871 0.888, p = 0.048], RA (OR: 1.370, p < 0.001), and FS (OR: 0.887, p < 0.001) were independently associated with ms-TR. Conclusion Tricuspid regurgitation occurs in maintenance hemodialysis patients with ESRD. Na+ FS and RA were independently associated with ms-TR, and these parameters may be potential risk factors/predictors for ms-TR.
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Affiliation(s)
- Ying Zhang
- Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Kidney Center of PLA, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Xiao-Han Ding
- Department of Health Care and Geriatrics, The 940th Hospital of PLA Joint Logistics Support Force, Lanzhou, China
| | - Fang Pang
- Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Kidney Center of PLA, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Laiping Zhang
- Institute of Cardiovascular Diseases of PLA, Army Medical University (Third Military Medical University), Chongqing, China.,Department of Cardiology, Xinqiao Hospital, Chongqing, China
| | - Yiqin Wang
- Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Kidney Center of PLA, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Weili Wang
- Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Kidney Center of PLA, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Rongsheng Rao
- Department of Ultrasound, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Shi-Zhu Bian
- Institute of Cardiovascular Diseases of PLA, Army Medical University (Third Military Medical University), Chongqing, China.,Department of Cardiology, Xinqiao Hospital, Chongqing, China
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Abstract
Objective: Ultrafiltration rate is one of the major determinants of adverse outcomes in patients undergoing hemodialysis (HD) therapy. Previous studies have focused on the impact of HD on right ventricular (RV) peak strain values. However, the influence of HD on the temporal characteristics of deformation has not been reported yet. The aim of the present study was to evaluate the impact of high ultrafiltration rate (HUR) on RV mechanical dyssynchrony. Methods: Echocardiographic images focused on the RV and left ventricle (LV) were obtained from 60 patients (49.2±17.3 years, 22 female) before and after HD. Patients were divided into two groups according to ultrafiltration rate. Changes in echocardiographic parameters with HD were examined. Two-dimensional speckle-tracking strain analysis was used to assess deformation. Mechanical dispersion was measured as the standard deviation of time to peak longitudinal strain of six segments for RV and 18 segments for LV. Results: The average ultrafiltrated volume and ultrafiltration rate were 3000.1±1007.9 mL and 11.4±2.9 mL/kg/h, respectively. Global longitudinal strain (GLS) of the RV and LV decreased after HD in both groups. A significant difference was observed in RV mechanical dispersion with HD for patients in the high ultrafiltration group. A mild statistically insignificant increase in LV mechanical dispersion was also observed after HD. Conclusion: HUR has a substantial impact on LV and RV GLS and RV dyssynchrony. Ultrafiltration rates and volumes should be kept as low as possible to achieve hemodynamic stability and tolerability.
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