Diastolic dysfunction in asymptomatic hemodialysis patients in the light of the current echocardiographic guidelines

Malík, Jan; Kudlicka, Jaroslav; Valeriánová, Anna; Kovářová, Lucie; Kmentova, Tereza; Lachmanová, J

doi:10.1007/s10554-019-01564-2

Cited by 21 publications

(22 citation statements)

References 21 publications

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“…Current echocardiographic definition of the diastolic dysfunction is based on transmitral E/A ratio, early diastolic velocity of the mitral anulus, left atrial dilation and on the prove of elevated pulmonary artery pressure [10]. Transmitral E-wave is preloaddependent and significantly changes even after a single haemodialysis session [11]. It also decreased after Qa reduction as did also the left atrial volume.…”

Section: Discussionmentioning

confidence: 99%

“…LVH is the main cardiovascular risk factor and the most powerful predictor of mortality in ESRD patients [9]. Diastolic dysfunction is a frequent consequence of LVH and when analysed according to current guidelines [10], it is also preload (ultrafiltration) dependent [11] and predicts increased mortality [12]. The right heart is also affected by ESRD.…”

Section: Introductionmentioning

confidence: 99%

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Reduction of arteriovenous access blood flow leads to biventricular unloading in haemodialysis patients

Valeriánová

Malík

Janeckova

et al. 2021

International Journal of Cardiology

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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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Reduction of arteriovenous access blood flow leads to biventricular unloading in haemodialysis patients

Valeriánová

Malík

Janeckova

et al. 2021

International Journal of Cardiology

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“…In patients with ESRD, diastolic dysfunction is associated with high-left ventricular hypertrophy (LVH) as well as volume overload [15,16]. It is known that LVH is very common in ESRD patients and left ventricular mass index gradually increases after the start of HD [16,17].…”

Section: Discussionmentioning

confidence: 99%

“…It is known that LVH is very common in ESRD patients and left ventricular mass index gradually increases after the start of HD [16,17]. Therefore, diastolic dysfunction is common in ESRD patients and is a more common mechanism of heart failure than reduction of the ejection fraction in patients with ESRD [15,16]. But the number of studies associated with diastolic dysfunctionin patients with ESRD is low.…”

Section: Discussionmentioning

confidence: 99%

Use of SD-OCT to Quantitatively Evaluate Peripheral Congestion in Diastolic Dysfunction with a Role Model in Hemodialysis Patients with End-Stage Renal Disease.

ÖZDEMİR>

Efe

2021

Preprint

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Purpose: There is no practical quantitative tool to assess peripheral congestion in patients with congestive heart failure. In this study, we aimed to evaluate peripheral congestion by measuring choroidal thickness with SD-OCTin patients with end stage renal disease(ESRD). In addition, volume management by hemodialysis (HD) is often difficult in patients with ESRD. Volume overload or hypovolemia may increase morbidity and mortality in long-term HD patients. Therefore, it is important to determine the ideal ultrafiltration rate (UFR) for each patient. Also, we aimed to find a data to help determine the ideal UFR.Methods: Fifty HD patients with ESRD were divided into 3 groups according to diastolic functions. Patients with mild diastolic dysfunction were enrolled in Group1, those with moderate diastolic dysfunction were enrolled in Group 2, and those with severe diastolic dysfunction were enrolled in Group 3. Choroid was used to evaluate peripheral congestion and choroidal thickness (CT) was measured by optical coherence tomography (OCT) before and after HD.Results: The average CT before HD in Group 3 (259.3 ± 7.5 μm ) was significantly higher than in Group 1 (249.6 ± 9.4 μm) (p=0,015). The average CT after HD in Group 3 (224.1 ± 5.2 μm ) was significantly higher than in Group 1 (232.4 ± 9.3 μm) (p=0,033). The mean of DCT was significantly higher in Group 3 than in Group 1 (p< 0.001)Conclusion:DCT was correlated with diastolic function in ESRD patients undergoing HD, and further evaluation of diastolic function before HD may play a role in finding the ideal UFR.

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“…4 The systolic dysfunction, diastolic dysfunction and left ventricular hypertrophy are frequent occurrences in patients undergoing dialysis, which are related to higher cardiovascular morbidity and mortality among patients undergoing dialysis. [5][6][7][8][9] Echocardiography is commonly used and can provide accurate information on left ventricular function, chamber dimension and geometry, and presence of left ventricular hypertrophy. 5 Coenzyme Q10 (CoQ10), as an important in vivo antioxidant, is an essential component of the mitochondrial electron transport chain.…”

Section: Introductionmentioning

confidence: 99%

Effects of coenzyme Q10 on endothelial and cardiac function in patients undergoing haemodialysis: study protocol for a pilot randomised controlled trial

Zuo

et al. 2020

BMJ Open

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IntroductionEndothelial and cardiac dysfunction are highly prevalent and are associated with cardiovascular morbidity and mortality among patients undergoing dialysis. For patients undergoing dialysis, no study has explored the effect of supplementation of coenzyme Q10 (CoQ10) on endothelial function. To our best of knowledge, only two small sample studies focused on the efficacy of supplementation of CoQ10 on cardiac function. However, the effect of CoQ10 supplementation on cardiac function remains uncertain in patients who undergo haemodialysis. The aim of this study is to explore whether CoQ10 supplementation can improve endothelial and cardiac function in patients undergoing haemodialysis.Methods and analysisThis is a pilot randomised controlled study. Eligible patients undergoing haemodialysis in our haemodialysis centre will be randomly allocated to the CoQ10 and control groups. The follow-up time is 12 months. The primary outcome is to assess the change of brachial artery endothelial-dependent flow-mediated dilation, left ventricular systolic function, diastolic function and Myocardial Performance Index at 12 months from baseline. Secondary outcomes are death or hospitalisation due to cardiovascular events, all-cause mortality, change of CoQ10 concentration, the ratio of ubiquinol to ubiquinone, the change of oxidative stress markers (including malondialdehyde and 8-hydroxy-deoxyguanosine) and Left Ventricular Mass Index.Ethics and disseminationRisks associated with CoQ10 are minor, even at doses as high as 1800 mg according to previous studies. The trial has received ethics approval from the Medical Ethics Committee for Clinical Trials of Drugs, the 306th Hospital of Chinese PLA. The results of the study are expected to be published in a peer-reviewed journal and presented at academic conferences.Trial registration numberChiCTR1900022258.

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Diastolic dysfunction in asymptomatic hemodialysis patients in the light of the current echocardiographic guidelines

Cited by 21 publications

References 21 publications

Reduction of arteriovenous access blood flow leads to biventricular unloading in haemodialysis patients

Reduction of arteriovenous access blood flow leads to biventricular unloading in haemodialysis patients

Use of SD-OCT to Quantitatively Evaluate Peripheral Congestion in Diastolic Dysfunction with a Role Model in Hemodialysis Patients with End-Stage Renal Disease.

Effects of coenzyme Q10 on endothelial and cardiac function in patients undergoing haemodialysis: study protocol for a pilot randomised controlled trial

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