Current and novel imaging techniques to evaluate myocardial dysfunction during hemodialysis

Abstract

Purpose of review Patients on hemodialysis have significantly higher rates of cardiovascular mortality resulting from a multitude of myocardial dysfunctions. Current imaging modalities allow independent assessment of cardiac morphology, contractile function, coronary arteries and cardiac perfusion. Techniques such as cardiac computed tomography (CT) imaging have been available for some time, but have not yet had widespread adoption because of technical limitations related to cardiac motion, radiation exposure and safety of contrast agents in kidney disease. Recent findings Novel dynamic contrast-enhanced (DCE) CT imaging can be used to acquire high-resolution cardiac images, which simultaneously allow the assessment of coronary arteries and the quantitative measurement of myocardial perfusion. The advancement of recent CT scanners and cardiac protocols have allowed noninvasive imaging of the whole heart in a single imaging session with minimal cardiac motion artefact and exposure to radiation. Summary DCE-CT imaging in clinical practice would allow comprehensive evaluation of the structure, function, and hemodynamics of the heart in a short, well tolerated scanning session. It is an imaging tool enabling the study of myocardial dysfunction in dialysis patients, who have greater cardiovascular risk than nonrenal cardiovascular disease populations, both at rest and under cardiac stress associated with hemodialysis itself.

Update on Hemodialysis-Induced Multiorgan Ischemia

“…Initial PET-based study findings have been supported by further human intradialytic imaging studies. High-resolution computed tomography–based (with spatial resolution down to 3 mm) 71 and arterial spin labeled intradialytic cardiac MRI have revealed identical findings. 48 In addition, these studies have confirmed the linear relationship of ultrafiltration rate to the severity of hemodialysis-induced myocardial stunning (as assessed with tagged cardiac MRI and the number of new areas of segmental loss of contractile function regional wall motion abnormalities) 48 and that changes in myocardial perfusion are not associated with paired changes in larger coronary arterial blood flow.…”

The Next Evolution of HemoDialysis eXpanded: From a Delphi Questionnaire-Based Approach to the Real Life of Italian Dialysis Units

“…Among them, the most validated are the changes in echography assessment of left ventricle mass [ 46 ] or doppler estimation of arterial stiffness via pulse wave velocity [ 47 ]. A more recent technique (dynamic contrast-enhanced CT imaging) can be used to acquire high-resolution cardiac images and provide an accurate estimation of cardiac perfusion [ 48 ]. Moreover, regional and national study registry might improve and standardize the long-term follow-up of chronic HD patients reporting adverse events and causes of death using MCO.…”