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Keramida K, Papadopoulos K. Discrimination of myocardial function changes: Evolution of chronic kidney disease or hemodialysis effect? Echocardiography 2024; 41:e15811. [PMID: 38591130 DOI: 10.1111/echo.15811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 04/10/2024] Open
Affiliation(s)
- Kalliopi Keramida
- Cardiology Department, General Anti-Cancer, Oncological Hospital Agios Savvas, Athens, Greece
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Hunderup MM, Kampmann JD, Kristensen FB, Hafsund M. The short-term effect of hemodialysis on the level of high-sensitive cardiac troponin T - A systematic review. Semin Dial 2024; 37:110-116. [PMID: 37779378 DOI: 10.1111/sdi.13178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 09/10/2023] [Indexed: 10/03/2023]
Abstract
INTRODUCTION Patients with end-stage renal disease (ESRD) have an increased risk of cardiovascular disease, but interpreting cardiac troponin is difficult in this population. The effect of renal replacement therapy (RRT) is important to consider when interpreting serial cardiac troponin T (cTnT) results for patients with ESRD suspected of acute coronary syndrome (ACS). The aim of this systematic review is to answer how low-flux hemodialysis (LF-HD), high-flux hemodialysis (HF-HD), and hemodiafiltration (HDF) affect the blood concentration of high-sensitive cardiac troponin T (hs-cTnT). METHOD Several databases were searched and identified records were evaluated independently by two of the authors. Pre- and postdialysis hs-cTnT concentrations together with other relevant data were extracted from the included studies. The quality (potential bias and applicability issues) were assessed for each of the included studies. RESULTS The literature search identified 2,540 records and 15 studies were included. The relative pre- to postdialysis change of hs-cTnT varied from -41 to 29%. LF-HD increased the hs-cTnT concentration with relative changes between 2 and 17%. HDF decreased the concentration with relative changes from -41% to -9%. Both increases and decreases were seen for HF-HD (-16% to 12%). DISCUSSION/CONCLUSION In this systematic review, we found LF-HD to increase the hs-cTnT concentration and HDF to decrease the concentration. Results for HF-HD and unspecified HD are more heterogeneous. Because of the differences between the included studies, a meta-analysis was not meaningful. This systematic review can help with the assessment of patients with ESRD suspected of ACS in relation to hemodialysis/HDF treatment.
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Affiliation(s)
- Michael Mejer Hunderup
- Department of Clinical Biochemistry and Immunology, University Hospital of Southern Denmark, Aabenraa, Denmark
- Department of Clinical Biochemistry and Immunology, Lillebaelt Hospital, Vejle, Denmark
| | - Jan Dominik Kampmann
- Department of Internal Medicine, University Hospital of Southern Denmark, Sonderborg, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Frans Brandt Kristensen
- Department of Internal Medicine, University Hospital of Southern Denmark, Sonderborg, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Marius Hafsund
- Department of Internal Medicine, University Hospital of Southern Denmark, Sonderborg, Denmark
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Bathish Y, Beiruti K, Safadi H, Nov AS, Bukovetzky E, Edelstein M, Halabi M, Israeli Z. Effects of hemodialysis with cooled dialysate on high-sensitivity cardiac troponin I and brain natriuretic peptide. Hemodial Int 2022; 26:533-539. [PMID: 35852035 PMCID: PMC9796558 DOI: 10.1111/hdi.13039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 06/26/2022] [Accepted: 07/05/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Hemodialysis (HD) triggers recurrent and cumulative ischemic insults to the brain and the heart. Cooled dialysate may have a protective effect on major organs and improve hemodynamic tolerability of dialysis. The aim of the study was to compare HD with cooled dialysate with routine dialysis in terms of hemodynamic stability and levels of high-sensitivity Troponin I (hs-TnI) and N-terminal pro b-type natriuretic peptide (NTproBNP) pre and postdialysis. METHODS The 45 patients were randomized into two groups. The first group received a 35.5°C dialysate first (hypothermic dialysis) and the second group a 36.5°C dialysate first (routine dialysis). Then groups crossed over, so each group received the alternate dialysate (self-controls) For each patient, the first sample was collected at the beginning of dialysis, and a second sample was taken at the end of dialysis. RESULTS AND CONCLUSION hs-TnI and NTproBNP increased after routine HD by 10.7 ng\ml (p < 0.001) and (12.0 pg/μl) (p < 0.001), respectively, and by -3.1 ng\ml (p = 0.25) and (4.3 pg/μl) (p < 0.001), respectively after hypothermic HD. Our study results showed a tendency towards less rise in hsTnI and NTproBNP during hypothermic HD (35.5°C) as compared to routine HD (36.5°C). Neither arm experienced statistically significant changes in blood pressure. Further studies in larger cohorts and long follow up are warranted in order to confirm that lower rise in (hs-TnI) and NTproBNP actually translate into lower clinical risk for cardiovascular events.
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Affiliation(s)
- Younes Bathish
- Nephrology and Hypertension Unit, Cardiology departmentZiv Medical CentreSafedIsrael,Azrieli Faculty of MedicineBar‐Ilan UniversitySafedIsrael
| | - Karine Beiruti
- Nephrology and Hypertension Unit, Cardiology departmentZiv Medical CentreSafedIsrael
| | - Hussein Safadi
- Nephrology and Hypertension Unit, Cardiology departmentZiv Medical CentreSafedIsrael
| | - Adi Sharabi Nov
- Nephrology and Hypertension Unit, Cardiology departmentZiv Medical CentreSafedIsrael,Statistical UnitTel‐Hai Academic CollegeTel‐HaiIsrael
| | - Elena Bukovetzky
- Nephrology and Hypertension Unit, Cardiology departmentZiv Medical CentreSafedIsrael
| | - Michael Edelstein
- Nephrology and Hypertension Unit, Cardiology departmentZiv Medical CentreSafedIsrael,Azrieli Faculty of MedicineBar‐Ilan UniversitySafedIsrael
| | - Majdi Halabi
- Nephrology and Hypertension Unit, Cardiology departmentZiv Medical CentreSafedIsrael,Azrieli Faculty of MedicineBar‐Ilan UniversitySafedIsrael
| | - Zeev Israeli
- Nephrology and Hypertension Unit, Cardiology departmentZiv Medical CentreSafedIsrael,Azrieli Faculty of MedicineBar‐Ilan UniversitySafedIsrael
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High-Sensitivity Troponin: A Review on Characteristics, Assessment, and Clinical Implications. DISEASE MARKERS 2022; 2022:9713326. [PMID: 35371340 PMCID: PMC8965602 DOI: 10.1155/2022/9713326] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/17/2022] [Accepted: 02/22/2022] [Indexed: 12/12/2022]
Abstract
The use of high-sensitivity cardiac troponin (hs-cTn) assays has become part of the daily practice in most of the laboratories worldwide in the initial evaluation of the typical chest pain. Due to their early surge, the use of hs-cTn may reduce the time needed to recognise myocardial infarctions (MI), which is vital for the patients presenting in the emergency departments for chest pain. The latest European Society of Cardiology Guidelines did not only recognise their central role in the diagnosis algorithm but also recommended their use for rapid rule-in/rule-out of MI. High-sensitivity cardiac troponins are also powerful prognostic markers for long-term events and mortality, not only in a wide spectrum of other cardiovascular diseases (CVD) but also in several non-CVD pathologies. Moreover, these biomarkers became a powerful tool in special populations, such as paediatric patients and, most recently, COVID-19 patients. Although highly investigated, the assessment and interpretation of the hs-cTn changes are still challenging in the patients with basal elevation such as CKD or critically ill patients. Moreover, there are still various analytical characteristics not completely understood, such as circadian or sex variability, with major clinical implications. In this context, the present review focuses on summarizing the most recent research in the current use of hs-cTn, with a main consideration for its role in the diagnosis of MI but also its prognostic value. We have also carefully selected the most important studies regarding the challenges faced by clinicians from different specialties in the correct interpretation of this biomarker. Moreover, future perspectives have been proposed and analysed, as more research and cross-disciplinary collaboration are necessary to improve their performance.
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Idrovo A, Pignatelli R, Loar R, Nieuwsma A, Geer J, Solomon C, Swartz S, Ghanayem N, Akcan-Arikan A, Srivaths P. Preserved Cerebral Oxygenation with Worsening Global Myocardial Strain during Pediatric Chronic Hemodialysis. J Am Soc Nephrol 2021; 32:2912-2919. [PMID: 34518280 PMCID: PMC8806109 DOI: 10.1681/asn.2021020193] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 08/03/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Cerebral and myocardial hypoperfusion occur during hemodialysis in adults. Pediatric patients receiving chronic hemodialysis have fewer cardiovascular risk factors, yet cardiovascular morbidity remains prominent. METHODS We conducted a prospective observational study of pediatric patients receiving chronic hemodialysis to investigate whether intermittent hemodialysis is associated with adverse end organ effects in the heart or with cerebral oxygenation (regional tissue oxyhemoglobin saturation [rSO2]). We assessed intradialytic cardiovascular function and rSO2 using noninvasive echocardiography to determine myocardial strain and continuous noninvasive near-infrared spectroscopy for rSO2. We measured changes in blood volume and measured central venous oxygen saturation (mCVO2) pre-, mid-, and post-hemodialysis. RESULTS The study included 15 patients (median age, 12 years; median hemodialysis vintage, 13.2 [9-24] months). Patients were asymptomatic. The rSO2 did not change during hemodialysis, whereas mCVO2 decreased significantly, from 73% to 64.8%. Global longitudinal strain of the myocardium worsened significantly by mid-hemodialysis and persisted post-hemodialysis. The ejection fraction remained normal. Lower systolic BP and faster blood volume change were associated with worsening myocardial strain; only blood volume change was significant in multivariate analysis (β-coefficient, -0.3; 95% confidence interval [CI], -0.38 to -0.21; P<0.001). Blood volume change was also associated with a significant decrease in mCVO2 (β-coefficient, 0.42; 95% CI, 0.07 to 0.76; P=0.001). Access, age, hemodialysis vintage, and ultrafiltration volume were not associated with worsening strain. CONCLUSIONS Unchanged rSO2 suggested that cerebral oxygenation was maintained during hemodialysis. However, despite maintained ejection fraction, intradialytic myocardial strain worsened in pediatric hemodialysis and was associated with blood volume change. The effect of hemodialysis on individual organ perfusion in pediatric versus adult patients receiving hemodialysis might differ.
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Affiliation(s)
- Alexandra Idrovo
- Department of Pediatrics, Renal Section, Baylor College of Medicine/Texas Children’s Hospital, Houston, Texas
| | - Ricardo Pignatelli
- Department of Pediatrics, Cardiology Section, Baylor College of Medicine/Texas Children’s Hospital, Houston, Texas
| | - Robert Loar
- Department of Pediatrics, Cardiology Section, Baylor College of Medicine/Texas Children’s Hospital, Houston, Texas
| | - Asela Nieuwsma
- Department of Pediatrics, Cardiology Section, Baylor College of Medicine/Texas Children’s Hospital, Houston, Texas
| | - Jessica Geer
- Department of Pediatrics, Renal Section, Baylor College of Medicine/Texas Children’s Hospital, Houston, Texas
| | - Catharina Solomon
- Department of Pediatrics, Renal Section, Baylor College of Medicine/Texas Children’s Hospital, Houston, Texas
| | - Sarah Swartz
- Department of Pediatrics, Renal Section, Baylor College of Medicine/Texas Children’s Hospital, Houston, Texas
| | - Nancy Ghanayem
- Department of Pediatrics, Critical Care Section, Baylor College of Medicine/Texas Children’s Hospital, Houston, Texas
| | - Ayse Akcan-Arikan
- Department of Pediatrics, Renal Section, Baylor College of Medicine/Texas Children’s Hospital, Houston, Texas,Department of Pediatrics, Critical Care Section, Baylor College of Medicine/Texas Children’s Hospital, Houston, Texas
| | - Poyyapakkam Srivaths
- Department of Pediatrics, Renal Section, Baylor College of Medicine/Texas Children’s Hospital, Houston, Texas
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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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Changes of cardiac functions after hemodialysis session in pediatric patients with end-stage renal disease: conventional echocardiography and two-dimensional speckle tracking study. Pediatr Nephrol 2020; 35:861-870. [PMID: 31925535 DOI: 10.1007/s00467-019-04460-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/31/2019] [Accepted: 12/17/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Although acute effects of hemodialysis (HD) on cardiac functions in end-stage renal disease (ESRD) have been studied frequently in adults, limited data are available in pediatric age. Therefore, this work elucidates the acute impact of HD on cardiac functions using conventional echocardiography and two-dimensional (2D) speckle tracking in ESRD pediatric patients. METHODS Between June 2018 and April 2019, 40 ESRD pediatric subjects on chronic HD were prospectively recruited. All patients were subjected to history taking and baseline laboratory tests. Anthropometric measures, heart rate, blood pressure, and bioimpedance were assessed before and after HD session. Moreover, conventional echocardiography including M.mode and Doppler parameters for valves, as well as left ventricle (LV) 2D speckle tracking were performed pre- and post-dialysis session. RESULTS The included patients mean age was 12.9 ± 2.9 years, and males were 24 (60%). Significant reductions in body weight and blood pressure were noted after sessions. Post-dialysis LV and left atrial diameters, as well as left atrium to aortic diameter ratio, were lower. Nevertheless, conventional echocardiography-derived LV ejection fraction (EF), and fractional shortening were not significantly changed. Doppler-derived E/A ratio of mitral and tricuspid valves were lower post-dialysis. Global longitudinal strain (GLS) for LV was significantly reduced after dialysis (- 20.31 ± 3.58%, - 17.17 ± 3.40% vs, P < 0.0001), and global circumferential strain (GCS) was lower post-dialysis in comparison to pre-dialysis (- 21.37 ± 6.46% vs - 17.74 ± 6.16%, P < 0.0001). The speckle tracking-derived EF was significantly lower post-dialysis (57.58 ± 6.94 vs 53.64 ± 10.72, P = 0.018). All myocardial segments longitudinal and circumferential strains decreased significantly after dialysis. CONCLUSIONS Post-hemodialysis significant decline in left ventricular EF as well as global and segmental strains can be detected in ESRD pediatric patients using 2D speckle tracking, despite the nonsignificant changes in systolic functions derived from conventional echocardiography. This is considered additional evidence of HD deleterious effect on myocardial functions, particularly in the pediatric age.
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