Changes in left ventricular and atrial mechanics and function after dialysis in patients with end-stage renal disease
Xiaoyan Wang, Jian Hong, Tao Zhang, Di Xu
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, 51.016.4 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 (90.1823.91 vs. 84.2123.54 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; 82.2220.13 vs. 72.4318.32 cm/s, P<0.001), peak early diastolic tissue Doppler velocity (e'; 6.451.88 vs. 5.771.63 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 (0.900.27 vs. 0.790.23, P<0.001), and the average E/e' ratio (12.544.08 vs. 11.284.52, 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 (35.5512.61 vs. 30.229.80 mL/m 2 , P<0.001), tricuspid regurgitation velocity (260.1136.54 vs. 242.3732.22 cm/s, P=0.002), and pulmonary artery systolic pressure (33.6311.29 vs. 29.947.80 mmHg, P=0.006) significantly decreased. LV global longitudinal systolic strain (GLS) of 4-chamber view (-24.37%3.02% vs.