Long‐term impacts of hemodialysis on the right ventricle: Assessment via 3‐dimensional speckle‐tracking echocardiography

Abstract

Background Right ventricular (RV) dysfunction is a major cause of death in patients undergoing maintenance hemodialysis (MHD). We used 3‐dimensional speckle‐tracking echocardiography (3DSTE) to evaluate long‐term impacts of MHD on RV function. Hypothesis In this study, RV dysfunction in MHD patients will be revealed and studied in depth by 3DSTE. Methods Echocardiography was performed on 110 consecutively enrolled individuals: 30 controls and 80 patients with MHD. Conventional echocardiographic parameters and 3DSTE parameters were obtained and compared between groups. Univariate and multivariate logistic regression analysis identified independent predictors of intradialytic hypotension (IDH). Results Compared with the control group, RV end‐diastolic volume (RVEDV) was markedly enlarged (46.1 ± 11.8 mL/m2 vs 42.3 ± 8.6 mL/m2; P = 0.047), whereas RV ejection fraction (RVEF) was significantly lower in the MHD group (50.6% ± 5.8% vs 55.2% ± 3.7%; P < 0.001). RV global, septal, and lateral wall longitudinal strains were also decreased in the MHD group (−18.2 ± 3.6 vs −22.6 ± 4.3%; −13.1 ± 3.8 vs −17.5 ± 5.5%; and −23.4 ± 4.7 vs −27.7 ± 4.0%, respectively; all P < 0.001). RVEF (odds ratio [OR]: 0.72, 95% confidence interval [CI]: 0.51 to 1.01, P = 0.038) and history of diabetes (OR: 11.14, 95% CI: 1.16 to 106.71, P = 0.036) were 2 independent predictors of IDH. Ultrafiltration rate was an independent factor associated with RVEF (β = −0.01, 95% CI: −0.019 to 0.001, P = 0.039). Conclusions RVEF by 3DSTE could be an important predictor of IDH in MHD patients, and lower ultrafiltration rate was protective for RVEF. 3DSTE may have potential in RV evaluation and risk stratification in MHD patients.

Dynamic Echocardiographic Assessments Reveal Septal E/e’ Ratio as Independent Predictor of Intradialytic Hypotension in Maintenance for Hemodialysis Patients with Preserved Ejection Fraction

“…Our findings of the association between diastolic dysfunction and IDH were similar to those of another study [ 16 ]. The mechanisms involving IDH are multifactorial, including inadequate intravascular volume refilling, autonomic dysfunction, abnormal vascular compliance and poor cardiac performance such as LV systolic and diastolic dysfunction and acute hypovolemia during ultrafiltration dialysis [ 17 ].…”

“…Our findings have also revealed that patients with IDH had greater increases in EF and greater decreases in mLVESV during HD. Previous studies have indicated a decline of EF at mid-HD as a possible predictor of IDH using real-time 3D echocardiography [ 8 , 16 ]. However, consecutive assessments of echocardiographic changes at three different time points of a single HD session enabled a more in-depth assessment of dynamic heart performances in IDH patients.…”

Right Ventricular Dysfunction and Adverse Outcomes after Renal Transplantation

“…Furthermore, hemodialysis involves large and frequent fluid shifts. RV dysfunction has been associated with intradialytic hypotension, which results in myocardial stunning and ischemia [23]. While we found that duration of dialysis was not significantly associated with development of RV dysfunction or RV dilation, this may be a consequence of evaluating a small study population.…”

Clinical Utility of Three-Dimensional Speckle-Tracking Echocardiography in Heart Failure

“…Hence, 3D-STE displays the potential to identify patients with HFpEF at high risk of poor clinical outcomes [ 95 ]. In addition, the main causes of death in maintenance hemodialysis patients are cardiovascular disease, and RV dysfunction is associated with increased cardiovascular morbidity and mortality [ 96 ]. Sun et al investigated the RV function in 80 patients with maintenance hemodialysis and 30 healthy subjects using 3D-STE.…”