Hemodialysis improves myocardial interstitial edema and left ventricular diastolic function in patients with end-stage renal disease: noninvasive assessment by ultrasonic tissue characterization

Abstract

Congestive heart failure is the most common cause of mortality in patients with end-stage renal disease (ESRD). Ultrasonic tissue characterization with integrated backscatter offers a promising method for the noninvasive assessment of regional myocardial contractile performance and fibrosis. The aim of this study was to investigate the effect of hemodialysis (HD) on myocardial tissue characterization and left ventricular function in ESRD patients. We examined 26 patients with ESRD undergoing routine HD (age 63 +/- 12 years, duration of HD 9.2 +/- 3.2 years) and 30 patients with essential hypertension (HT; 60 +/- 10 years). Routine echocardiographic parameters and the cyclic variation of ultrasonic integrated backscatter of the ventricular septum (CV-IBS) were measured. Left ventricular mass index was significantly larger in patients with ESRD than in those with HT (217 +/- 56 vs 146 +/- 45 g/m(2), P < 0.05). The indices for left ventricular diastolic function (E/A, the ratio of left ventricular peak early to late diastolic filling velocity; DT, the deceleration time of the early diastolic filling) and CV-IBS had deteriorated significantly in patients with ESRD before HD compared with those with HT (E/A, 0.6 +/- 0.2 vs 0.9 +/- 0.3, P < 0.05; DT, 228 +/- 23 vs 184 +/- 19 ms, P < 0.05; CV-IBS, 9.0 +/- 1.3 vs 12.4 +/- 0.9 dB, P < 0.05), possibly reflecting interstitial fibrosis. In patients with ESRD, HD reduced calculated left ventricular mass index by 19% (before HD, 217 +/- 56 vs immediately after HD, 176 +/- 45 g/m(2), P < 0.05) and CV-IBS by 19% (9.0 +/- 1.3 vs 7.3 +/- 1.1 dB, P < 0.05), that possibly reflected improvement of interstitial edema. HD also significantly improved indices for left ventricular diastolic function (E/A, 0.6 +/- 0.2 vs 0.9 +/- 0.2, P < 0.05; DT, 228 +/- 23 vs 188 +/- 21 ms, P < 0.05). HD improves myocardial interstitial edema and left ventricular diastolic function in patients with ESRD. Noninvasive assessment of ultrasonic tissue characterization is useful in defining the pathophysiological changes of ventricular myocardium in patients with ESRD.

Supplementary Ultrafiltration May Improve Inflammation and Cardiac Dysfunction in Patients with High Interdialytic Weight Gain

“…Such findings were reported in earlier studies which evaluated the impact of strict volume control by different modalities [28,29]. As shown in a previous study, it is possible that a decrease in interstitial edema of the myocardium per se may also be responsible for the improvement in left ventricular dysfunction [30]. Additionally, experimental studies showed that the magnitude of daily oscillations in ECFV may trigger a number of volume stretch-mediated autocrine and paracrine cascades (i.e.…”

A New Perspective on Cardiotoxicity of 5-Fluorouracil

“…Noninvasive assessment of ultrasonic tissue characterization with the IBS method is a novel promising diagnostic tool that was reported to be useful to determine the contractile performance and structural properties of ventricular myocardium [9,10]. Cardiac IBS is a direct, quantitative measure of properties of the myocardium rather than a test of systolic function.…”

“…However, the pathophysiology of 5-FU-associated adverse cardiac events is still controversial and conclusions are based on limited clinical studies and case reports of various previously used 5-FU-based regimens more than on solid experimental evidence [5][6][7][8]. Ultrasonic tissue characterization with integrated backscatter (IBS) is a novel promising diagnostic method for noninvasive assessment of regional myocardial contractile performance [9]. It has the potential to provide quantitative information that characterizes the functional and structural state of cardiac muscle [10].…”

Is haemodialysis useful in severe right heart failure?

“…Congestive heart failure is the most common cause of mortality in patients with end-stage renal disease [1,2]. Chronic hypervolemia and uremia may negatively affect the myocardium of both ventricles [1].…”

“…Chronic hypervolemia and uremia may negatively affect the myocardium of both ventricles [1]. Preload reduction by haemodialysis improves myocardial interstitial edema and left ventricular diastolic function in patients with end-stage renal disease and congestive heart failure [2].…”