Dissociation between Alterations in Myocardial Perfusion and R-Wave Amplitude after Hemodialysis

Wizemann, V.; Krämer, W; Thormann, J

doi:10.1159/000183081

Cited by 5 publications

(4 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…None of these changes related to age, sex, presence of hypertension, weight loss, premedica tion or sodium dialysate concentrations. A selected group of 18 patients showed a discordance between aug mentation of left ventricular performance, myocardial perfusion assessed by radionuclide technique, exercise capacity and R-wave response [3]. Our findings are in good agreement with several previously published data, which found R-wave changes unreliable as a predictor of myocardial ischemia [4][5][6].…”

supporting

confidence: 88%

See 1 more Smart Citation

Diagnostic Accuracy of Thallium-201 Myocardial Perfusion Imaging in Detecting Ischemia in Patients on Regular Dialysis Treatment

Krämer¹,

Wizemann²,

Thormann³

et al. 1984

Nephron

Self Cite

View full text Add to dashboard Cite

supporting

confidence: 88%

“…(I) Recently, we have demonstrated the difficulties of using R-wave amplitude changes to identify either is chemia or left ventricular dysfunction in patients on RDT [3]. We investigated 94 patients on RDT pre-and postdi alysis.…”

mentioning

confidence: 99%

Diagnostic Accuracy of Thallium-201 Myocardial Perfusion Imaging in Detecting Ischemia in Patients on Regular Dialysis Treatment

Krämer¹,

Wizemann²,

Thormann³

et al. 1984

Nephron

Self Cite

View full text Add to dashboard Cite

“…The above explanation in QRS amplitude increase during hemodialysis is supported by the relation of dialysate sodium concentration and QRS amplitude noted by Ono et al [2] and Wizemann et al [11]. Ono et al [2] perceived a positive correlation between an increase in QRS amplitude and the weight loss/dry weight ratio of patients only after standard sodium dialysis.…”

Section: Discussionmentioning

confidence: 81%

QRS Amplitude and Volume Changes during Hemodialysis

Ojanen¹,

Kööbi

Korhonen³

et al. 1999

Am J Nephrol

View full text Add to dashboard Cite

Background: According to several studies the QRS amplitude of the ECG increases during hemodialysis. The detailed background to this phenomenon has not been defined. Two main mechanisms have been suggested: myocardial ischemia and volume changes. New noninvasive technologies make possible a comparison of QRS complex changes synchronously with myocardial ischemia and extracellular water (ECW)/blood volume (BV) changes during hemodialysis. Methods: In this study hemodialysis-related changes in body weight, biochemical blood variables, BV, ECW, ST segment and QRS complex were analyzed in 15 patients (age 36–76, time on dialysis 0–6 years) undergoing chronic hemodialysis treatment. QRS complex and ST segment changes were measured using a dynamic vectorcardiographic monitoring system. The ECG parameters measured were QRS vector difference (QRS-VD) and ST vector magnitude (ST-VM6). Bioimpedance analysis was used to detect changes in the ECW. Continuous measurement of BV changes was implemented using an on-line optical reflection method based on the reflection of infrared light by erythrocyte membranes. Blood hemoglobin (B-Hb), hematocrit (B-Hcr), plasma sodium (P-Na), chloride (P-Cl), magnesium (P-Mg), potassium (P-K), ionized calcium (P-iCa), phosphate (P-Pi), creatinine (P-Crea) and urea (S-Urea) were monitored. Results: The mean QRS-VD increase during the dialysis session was almost fourfold (372 ± 300%) from 4.16 ± 2.40 to 15.60 ± 7.0 μVs (p < 0.001). This change was due to a change in amplitude, since the duration of the QRS complex did not alter significantly. The correlation between the changes in QRS-VD and body weight from the start to the end of the dialysis session was moderate and statistically significant (r = –0.55, p < 0.05). The correlation between the changes in QRS-VD and ECW varied from r = –0.67 to –0.97, being statistically significant in all patients (p < 0.001). The correlation between BV and QRS-VD was assessed at one minute intervals during the dialysis and varied from r = –0.22 to –0.98, being significant in 14 of the 15 patients (p < 0.001). Significant ST segments alterations (ST-VM6 elevation > 100 μV) did not occur during dialysis. Laboratory parameters reflecting volume and osmotic changes during hemodialysis correlated with QRS-VD change: B-Hcr (r = 0.56, p < 0.05), B-Hb (r = 0.63, p < 0.05), P-Na (r = 0.62, p < 0.05) and S-Urea (r = –0.62, p < 0.05). Conclusions: The increase in QRS complex amplitude during hemodialysis is correlated to reduced ECW. The mechanism involved is most probably augmentation of electrical resistance of the tissues around the heart caused by loss of interstitial fluid.

show abstract

“…Ono et al [25] also reported a positive correlation between an increase in R wave amplitude (V5 + V6) and the weight loss ratio during hemodialysis, and regarded an increase in the R wave as myocardial ischemia. In this regard, Wizemann [26] emphasized that an increase in R-wave amplitude after hemodialysis might not lead to the erroneous conclusion of myocardial ischemia. Cer tainly, a dialysis membrane induced vasospasm from defi cient endothelium-dependent relaxation factor production or increased response to endothelin.…”

Section: Discussionmentioning

confidence: 99%

Effects of Hemodialysis on Body Surface Maps in Patients with Chronic Renal Failure

Katoh

Kimura

Kamakura

et al. 1993

Nephron

View full text Add to dashboard Cite

To examine the effects of hemodialysis on the electrocardiogram, 87-lead body surface maps were performed in 38 patients with chronic renal failure, before and after hemodialysis. The patients were divided into two groups; 16 patients with coronary artery disease (CAD group), and 22 patients without ischemic heart disease (control group). Three maps were analyzed, QRS isopotential maps, isochrone maps, and QRS isointegral maps. Parameters measured were maximal R wave voltage (Peak R), minimal QRS wave voltage (Peak S), maximal ventricular activation time (VAT_max) and QRS duration (QRSd). In the control group, Peak R and Peak S increased but VAT_max decreased after hemodialysis. There were negative correlations between the changes of body weight and the changes in Peak R (r = -0.67, p < 0.01) and Peak S (r = -0.87, p < 0.001), although there were no correlations between changes in left ventricular diastolic dimension and the changes in Peak R and Peak S. In the CAD group, Peak S increased but Peak R and VAT_max did not change significantly. There were negative correlations between the change of body weight and the change of Peak S (r = -0.73, p < 0.01). The most pronounced changes in mean QRS isointegral maps on hemodialysis were an increased magnitude of positivity in the control group and negativity in the CAD group on the anterior thorax. These findings suggested that the increase in the QRS amplitude after hemodialysis was influenced by the changes of the conductivity of extracardiac thorax and the relative heart position to the chest wall rather than myocardial ischemia or ventricular conduction delay.

show abstract

Dissociation between Alterations in Myocardial Perfusion and R-Wave Amplitude after Hemodialysis

Cited by 5 publications

References 5 publications

Diagnostic Accuracy of Thallium-201 Myocardial Perfusion Imaging in Detecting Ischemia in Patients on Regular Dialysis Treatment

Diagnostic Accuracy of Thallium-201 Myocardial Perfusion Imaging in Detecting Ischemia in Patients on Regular Dialysis Treatment

QRS Amplitude and Volume Changes during Hemodialysis

Effects of Hemodialysis on Body Surface Maps in Patients with Chronic Renal Failure

Contact Info

Product

Resources

About