Evaluation of cardiac function in the dialysis patient—a primer for the non-expert

Ie, Eric H.Y.; Zietse, Robert

doi:10.1093/ndt/gfl167

Cited by 20 publications

(26 citation statements)

References 45 publications

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“…A compensatory increase in the late atrial phase of LV filling (A wave) occurs in patients with impaired LV compliance or abnormal relaxation, which results in a reduced E/A ratio. This situation is designated "impaired relaxation", considering the diastolic dysfunction diagnosis (18). Our ECHO data confirm the presence of HD-induced diastolic dysfunction in ESRD patients.…”

Section: Discussionsupporting

confidence: 63%

Acute Haemodialysis-induced Changes in Tissue Doppler Echocardiography Parameters

Sağ¹,

Yeşilbursa²,

Yıldız³

et al. 2014

Balkan Med J

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Cardiovascular diseases are common in patients with endstage renal disease (ESRD) and are the main causes of morbidity and mortality (1)(2)(3). A large body of evidence has accrued indicating that a portion of this cardiovascular damage may be due to haemodialysis (HD) (4,5). Notably, cardiovascular events contribute to increased death rates (10-to 20-fold) in HD patients compared to the general population, regardless of gender, race, and the general risk factors associated with heart disease (6). Short recurrent HD therapy is recognized to have a positive impact on haemodynamics, and approximately 20-30% can be convoluted by major intradialytic hypotension attacks (7). Previous studies have also shown that HD is known to induce haemodynamic instability through the development of subclinical myocardial ischemia, (8). Interestingly, sudden death appears to cause cardiovascular death in HD patients (9). There is evidence suggesting that cardiac arrhythmias are caused by abnormal ventricular morphology and function in this group of patients (10). Therefore, studying changes in cardiac functions induced by HD may be of significant clinical value.Cardiac function is routinely measured using diagnostic imaging techniques. Echocardiography (ECHO) is a conventional method that can measure systolic and diastolic functions of the right ventricle (RV) and left ventricle (LV). However, most traditional ECHO parameters of LV and RV diastolic and systolic functions are affected by alterations in loading conditions and are therefore called load-dependent (11). In HD patients, loading influence is principal for the functional examination of the heart. Certainly, the alterations in volume status cause significant changes in preload and afterload and ultimately effect the LV diastolic function measurements (12)(13)(14). The use of newer Doppler techniques that can examine cardiac function independent of volume status, such as tissue Doppler imaging (TDI), may prove useful for early diagnosis (12, 13). TDI can adequately measure relaxation and contraction velocities from the myocardium and has been recommended as quantitative and relatively load-independent (11,14). Throughout HD treatment, the intravascular volume of these patients is reduced a plausible group to investigate the role of acute preload Background: Tissue Doppler imaging (TDI) is a method that determines the tissue motion and velocity within the myocardium. Aims: To characterize acute haemodialysis (HD)-induced changes in TDI-derived indices for patients that have end-stage renal disease (ESRD). Study Design: Cross sectional study. Methods: Conventional echocardiography and TDI methods were applied to study ESRD patients (n=58) before and after HD. Pulmonary venous flow, mitral inflow, and TDI signals of the lateral and septal mitral annulus were examined for the determination of altered left-ventricular diastolic filling parameters. Flow velocities from early-(E) and late-atrial (A) peak transmitral; peak pulmonary vein systolic (S) and diastolic (D); and myocardia...

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Section: Discussionsupporting

confidence: 63%

Acute Haemodialysis-induced Changes in Tissue Doppler Echocardiography Parameters

Sağ¹,

Yeşilbursa²,

Yıldız³

et al. 2014

Balkan Med J

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“…Normalna vrednost za ranu dijastolu kod mlađih osoba iznosi > 10 cm/s, a kod starijih > 8 cm/s. Poremećaj dijastolne funkcije leve komore definiše se kao pik tkivne brzine mitralnog anulusa u ranoj dijastoli < 8 cm/s (26)(27)(28)(29). Za procenu dijastolne funkcije leve komore koristi se i brzina propagacije dijastolnog protoka (Vp), određena kolor Mmod doplerom (colour M-mode Doppler).…”

Section: Ehokardiografska Procena Dijastolne Funkcije Srcaunclassified

“…Za procenu dijastolne funkcije leve komore koristi se i brzina propagacije dijastolnog protoka (Vp), određena kolor Mmod doplerom (colour M-mode Doppler). Poremećaj dijastolne funkcije leve komore postoji kada je Vp < 45 cm/s (26)(27)(28)(29). Indeks volumena leve pretkomore (LAVi) pokazatelj je hroničnog povećanja pritiska punjenja leve komore kod bolesnika koji se leče hemodijalizom, a vrednosti LAVi > 32 ml/m 2 ukazuju na povećan rizik od nepovoljnog ishoda ovih bolesnika (26)(27)(28).…”

Section: Ehokardiografska Procena Dijastolne Funkcije Srcaunclassified

“…Drugi stadijum, stadijum pseudonormalizacije, kod koga je kriva transmitralnog protoka lažno normalna, odlikuje se odnosom E/A = 0,8-2,0, e' < 8 cm/s, odnos E/e' je između 9-12 i LAVi > 34 ml/m 2 . Kod teškog poremećaja dijastolne funkcije koji predstavlja stadijum 3 ili poremećaj restrikcije, odnos E/A > 2,0, e' < 8 cm/s, odnos E/e' je > 13 i LAVi > 34 ml/m 2 (često > 40 ml/m 2 ), tabela 1 (26)(27)(28).…”

Section: Ehokardiografska Procena Dijastolne Funkcije Srcaunclassified

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10.5937/mckg48-4123 = Diastolic heart failure in patients on hemodialysis: Etiopathogenesis, diagnostics and therapy

Nedeljković¹,

Miloradović²,

Radovanović³

et al. 2014

Medicinski casopis

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UVODBolesti srca su vodeći uzrok smrti bolesnika koji se leče redovnim hemodijalizama. Kod ovih bolesnika prisutni su brojni faktori rizika kao što su povišen arterijski krvni pritisak, poremećaj metabolizma lipida, oksidativni stres, mikroinflamacija, hiperhomocisteinemija, anemija, povećan protok krvi kroz vaskularni pristup za hemodijalizu, sekundarni hiperparatireoidizam, a koji su odgovorni za razvoj kardiovaskularnih komplikacija (1). Hipertrofija leve komore, ishemijska bolest srca i srčana slabost su najčešće kardiovaskularne komplikacije kod bolesnika na hemodijalizi (1, 2). PREGLED SAŽETAK

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“…Normal values are ≤131 g/m 2 for men and ≤ 100 g/m 2 for women (10)(11)(12). Left ventricular fractional shortening (LVFS), representing a measure of systolic function, is normally 42 ± 8% (10)(11)(12).…”

Section: Echocardiographymentioning

confidence: 99%

Cardiovascular Mortality in Hemodialysis Patients: Clinical and Epidemiological Analysis

Petrović¹,

Obrenović²,

Trbojević-Stanković³

et al. 2011

Journal of Medical Biochemistry

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Summary: Cardiovascular diseases are the leading cause of death in hemodialysis (HD) patients. The annual cardiovascular mortality rate in these patients is 9%, with left ventricular (LV) hypertrophy, ischemic heart disease and heart failure being the most prevalent causes of death. The aim of this study was to determine the cardiovascular mortality rate and estimate the influence of risk factors on cardiovascular mortality in HD patients. A total of 115 pa tients undergoing HD for at least 6 months were inves ti gated. Initially a cross-sectional study was performed, follo wed by a two-year follow-up study. Beside the standard bio chemical parameters, C-reactive protein (CRP), homo cysteine, cardiac troponins (cTn) and the echocardiographic parameters of LV morphology and function (LV mass index, LV fractional shortening, LV ejection fraction) were deter mined. Results were analyzed using Cox regression analysis, Kaplan-Meier and Log-Rank tests. The average one-year cardiovascular mortality rate was 8.51%. Multivariate Cox regression analysis identified increased CRP, cTn T and I, and LV mass index as independent risk factors for cardiovascular mortality. Patients with cTnT > 0.10 ng/mL and CRP > 10 mg/L had significantly higher cardio vas cular mortality risk (p < 0.01) than patients with cTnT > 0.10 ng/mL and CRP ≤ 10 mg/L and those with cTnT ≤ 0.10 ng/mL and CRP ≤ 10 mg/L (p < 0.01). HD pa tients with high cTnT and CRP have a higher cardiovascular mor tality risk.Keywords: C-reactive protein, cardiovascular mortality, hemodialysis, risk factors, troponin T Kratak sadr`aj: Kardiovaskularne bolesti su vode}i uzrok smrti bolesnika koji se le~e hemodijalizom. Jednogodi{nja stopa kardiovaskularnog mortaliteta iznosi 9%, a od kardiovaskularnih bolesti najve}u prevalenciju imaju hipertrofija leve komore, ishemijska bolest srca i sr~ana slabost. Cilj rada je bio da se utvrdi stopa kardiovaskularnog mortaliteta i da se ispita uticaj faktora rizika na razvoj kardiovas kularnog mor taliteta kod bolesnika na hemodijalizi. Ispitano je 115 bolesnika koji se le~e hemodijalizom du`e od {est meseci. Prvo je obavljena studija preseka, a zatim pra}enje bolesnika u dvogodi{njem vremenskom periodu. Parametri ispitivanja obuhvatili su koncentraciju C-reaktivnog proteina, homoci steina, sr~anog troponina T i I, kao i ehokardio grafske pa ra metre morfologije i funkcije leve komore. Za statisti~ku analizu dobijenih podataka kori{}eni su Co xova regresiona analiza, Kaplan-Meierov test i Log-Ran kov test. Utvr|eno je da prose~na jednogodi{nja stopa kardiovaskularnog mor taliteta iznosi 8,51%. Multi vari jantna Co xo va regre siona analiza je po kazala da su pove}ana koncentracija C-reaktivnog prote ina, sr~anog troponina T i I, i pove}an indeks mase leve komore nezavisni faktori rizika za na stanak kardio vasku larnog mortaliteta. Bolesnici kod kojih je koncentracija sr~a nog troponina T -cTnT > 0,10 ng/mL i koncentracija CRP > 10 mg/L imaju statisti~ki veoma zna ~ajno (p < 0,01) ve}i rizik od kardiovaskularnog mortaliteta u odnosu n...

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Evaluation of cardiac function in the dialysis patient—a primer for the non-expert

Cited by 20 publications

References 45 publications

Acute Haemodialysis-induced Changes in Tissue Doppler Echocardiography Parameters

Acute Haemodialysis-induced Changes in Tissue Doppler Echocardiography Parameters

10.5937/mckg48-4123 = Diastolic heart failure in patients on hemodialysis: Etiopathogenesis, diagnostics and therapy

Cardiovascular Mortality in Hemodialysis Patients: Clinical and Epidemiological Analysis

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