Relation between right and left ventricular function in patients undergoing chronic dialysis

Paneni, Francesco; Gregori, Mario; Ciavarella, Giuseppino Massimo; Sciarretta, Sebastiano; Palano, Francesca; Pignatelli, Giulia; Castello, Lorenzo; Domenici, Alessandro; Punzo, Giorgio; Biase, Luciano De; Menè, Paolo; Volpe, Massimo

doi:10.2459/jcm.0b013e32834eacf0

Cited by 24 publications

(29 citation statements)

References 27 publications

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“…ESRD, end-stage renal disease; AVF, arteriovenous fistula; RV, right ventricular; LV, left ventricular; ILVM, inappropriate left ventricular mass. line with these studies, we reported for the first time that right-to-left ventricular interdependence represents a putative mechanism underlying LV dysfunction in patients undergoing chronic dialysis [10]. Particularly, AVF seems to be critically involved in this phenomenon (Fig.…”

supporting

confidence: 72%

“…1). In a further study we investigated the role of AVF-induced RV dysfunction as a putative determinant of LV dysfunction in dialysis patients without overt cardiovascular disease [10]. Interestingly, myocardial performance index (MPI) of the right ventricle inversely correlated with both conventional and TDI indices of LV systolic and diastolic function and was independently associated with reduced LV ejection fraction.…”

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confidence: 96%

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Pathophysiology of biventricular dysfunction during hemodialysis: Emerging concepts

Paneni

Gregori²,

Pignatelli³

et al. 2012

International Journal of Cardiology

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confidence: 72%

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confidence: 96%

Pathophysiology of biventricular dysfunction during hemodialysis: Emerging concepts

Paneni

Gregori²,

Pignatelli³

et al. 2012

International Journal of Cardiology

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“…RV systolic dysfunction was independently associated with poor survival even when modeled with age, gender, diabetes, ESRD cause, and AV fistula access in a multivariable analysis. RV dysfunction in HD patients is thought to result from chronic volume overload and is exacerbated by AV fistula access, especially in the brachial position (27,28). RV dysfunction in turn leads to an impaired LV.…”

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confidence: 99%

Echocardiography Criteria for Structural Heart Disease in Patients With End-Stage Renal Disease Initiating Hemodialysis

Hickson

Negrotto

Onuigbo

et al. 2016

Journal of the American College of Cardiology

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Background Cardiovascular disease among hemodialysis (HD) patients is linked to poor outcomes. The Acute Dialysis Quality Initiative Workgroup proposed echocardiographic (ECHO) criteria for structural heart disease (SHD) in dialysis patients. The association of SHD with patient-important outcomes is not well defined. Objectives We determined prevalence of ECHO determined SHD and its association with survival among incident HD patients. Methods We analyzed patients initiating chronic HD from 2001-2013 who underwent ECHO ≤ 1 month prior to or ≤ 3 months following HD initiation (n = 654). Results Mean patient age was 66 ± 16 years, and 60% of patients were male. ECHO findings that met 1 or more and ≥ 3 of the new criteria were discovered in 87% and 54% of patients, respectively. Over a median of 2.4 years, 415 patients died: 108 (26%) died within 6 months. Five-year mortality was 62%. Age- and gender-adjusted structural heart disease variables associated with death were left ventricular ejection fraction (LEVF) ≤ 45% (HR 1.48, CI 1.20-1.83) and right ventricular (RV) systolic dysfunction (HR 1.68, CI 1.35-2.07). An additive of higher death risk included LVEF ≤ 45% and RV systolic dysfunction rather than neither (HR 2.04, CI 1.57-2.67; p = 0.53 for test for interaction). Following adjustment for age, gender, race, diabetic kidney disease, and dialysis access, RV dysfunction was independently associated with death (HR 1.66; CI 1.34-2.06; p < 0.001). Conclusions SHD was common in our hemodialysis study population, and RV systolic dysfunction independently predicted mortality.

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“…RV dysfunction is prevalent among patients with ESRD receiving hemodialysis (25). RV overload and dysfunction may contribute to LV dysfunction through interventricular dependence (26). The current study in this issue of CJASN is the first to report on the beneficial effect of frequent daily hemodialysis on RV end-diastolic volume (RVEDV) and, to a lesser extent, on RV end-systolic volume.…”

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The Effects of Frequent Hemodialysis on Left Ventricular Mass, Volumes, and Geometry

Mishra

Dubin

2013

Clinical Journal of the American Society of Nephrology

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Left ventricular (LV) remodeling is defined as ''the genomic expression resulting in molecular, cellular, and interstitial changes that are manifested clinically as changes in size, shape, and function of the heart after cardiac injury" (1). In ESRD, LV remodeling manifests features of both concentric and eccentric LV hypertrophy, resulting from enlarged LV volumes and increased LV wall thickness (2). As we discuss here, LV mass can change because of a change in LV wall thickness, LV cavity size, or both. Increased LV mass, increased LV end-diastolic volume (LVEDV), and changes in LV geometry (LV mass/LVEDV) are all associated with poor prognosis in these patients (3,4). The Frequent Hemodialysis Network (FHN) trial is the first large-scale randomized controlled trial of frequent daily and nocturnal dialysis versus conventional dialysis (5). FHN investigators previously demonstrated that, compared with conventional hemodialysis, frequent daily hemodialysis results in a significantly greater reduction in LV mass, as determined by cardiac magnetic resonance imaging (MRI) (6). In this issue of CJASN, this group reports that frequent daily dialysis resulted in greater reductions in LV and right ventricular (RV) volumes without significant changes in LV geometry (7). In addition, reductions in both LV mass and LVEDV with frequent dialysis were significantly correlated with reductions in predialysis systolic BP (6,7). Here we present a brief overview of the literature on the effects of dialysis on LV remodeling, discuss likely mechanisms underlying the findings of the current study, and reflect on implications for future investigation.Observational studies of frequent dialysis have shown salutary effects on BP (8-11) and LV mass index (12-15) and impressive survival rates (8,16). Moreover, LV hypertrophy has regressed in patients with ESRD who have baseline LV hypertrophy when aggressive management of BP and anemia was added to a thrice-weekly dialysis regimen (17,18). One such study shows that LV hypertrophy may regress without a change in relative wall thickness, another measure of LV geometry (18). In several studies, including the FHN trial, lowering BP was strongly associated with regression of LV hypertrophy (9,10,(12)(13)(14). Prior studies of frequent dialysis that evaluated LV size in addition to mass did not specifically address LV geometry (10,13).LV mass and volume are linked mathematically, physiologically, and empirically. Cardiac MRI is widely considered to be the gold standard for determining LV volume and mass, while M-mode echocardiography overestimates LV mass in patients with ESRD undergoing hemodialysis because of its geometric assumptions (19). In cardiac MRI, LV mass is calculated as myocardial volume multiplied by the specific density of the myocardium (20). Myocardial volume, in turn, is the difference between the enddiastolic epicardial volume and end-diastolic endocardial volume, excluding the papillary muscles (LVEDV). Thus, while MRI-determined LV mass is free of geometric assumptions, it ...

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Relation between right and left ventricular function in patients undergoing chronic dialysis

Abstract: AVF-induced RVD may contribute to LVD in dialysis patients. AVF plays a pivotal role in triggering LVD via right-to-left ventricular interdependence.

Cited by 24 publications

References 27 publications

Pathophysiology of biventricular dysfunction during hemodialysis: Emerging concepts

Pathophysiology of biventricular dysfunction during hemodialysis: Emerging concepts

Echocardiography Criteria for Structural Heart Disease in Patients With End-Stage Renal Disease Initiating Hemodialysis

The Effects of Frequent Hemodialysis on Left Ventricular Mass, Volumes, and Geometry

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