Rest and Exercise Response of Left Ventricular Functions of Patients on Maintenance Hemodialysis with and without Cornary Artery Disease

Wizemann, V.; Krämer, W.; Thormann, J; Kindler, M; Schlepper, M; Schütterle, G

doi:10.1159/000429295

Cited by 4 publications

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“…With the exception of one study [10] a persistent cardiac effect of anemia compensation in ESRD patients by ery thropoietin is a decrease in left-ventricular end-diastolic diameter [11][12][13][14][15] despite large variation in patient selection. Since it has been known that dialysis patients with con firmed CAD have an improved left ventricular function and myocardial perfusion as a consequence of ultrafiltration during dialysis [16], it can be suspected that a reduction of left ventricular dimensions improves compromised perfu sion in CAD and thereby myocardial function. This notion is further supported by the finding that the pumping func tion of left ventricles of dialysis patients with CAD is inversely related to end-diastolic volume [18].…”

Section: Discussionmentioning

confidence: 99%

Effect of Erythropoietin on Ischemia Tolerance in Anemic Hemodialysis Patients with Confirmed Coronary Artery Disease

Wizemann

Kaufmann

Krämer

1992

Nephron

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From a total of 81 patients on maintenance hemodialysis who underwent coronary angiography, 8 patients fulfilled the criteria: significant coronary artery disease, hematocrit < 27%, reproducible (ECG) positive treadmill test, no disturbance of repolarization in ECG at rest. Exercise stress testing was performed at a hematocrit of 25 ± 2% and following erythropoietin therapy at a hematocrit of 34 ± 0.5%. Symptom-limited exercise performance increased in all patients (1.10 ± 0.3 W/kg b.w. vs. 1.44 ± 0.31 W/kg b.w., p < 0.01) as well as exercise duration (489 vs. 362 s, p ± 0.01). ST segment depression during maximal exercise was reduced from a mean of 2.1 to 0.4 mm (p < 0.01). It is concluded that amelioration of renal anemia by erythropoietin in dialysis patients with significant coronary artery disease reduces exercise-induced myocardial ischemia.

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Section: Discussionmentioning

confidence: 99%

Effect of Erythropoietin on Ischemia Tolerance in Anemic Hemodialysis Patients with Confirmed Coronary Artery Disease

Wizemann

Kaufmann

Krämer

1992

Nephron

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Cardiac Arrhythmias in End-Stage Renal Disease: Prevalence, Risk Factors, and Management

Wizemann¹,

Krämer²

1992

Cardiac Dysfunction in Chronic Uremia

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Mechanisms of altered myocardial contractility during hemodialysis: Importance of changes in the ionized calcium to plasma potassium ratio

et al. 1985

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Hemodialysis is associated with alterations in myocardial contractility, but duration and precise determinants responsible for these changes are unknown. We investigated the effect of several variables, established to influence left ventricular (LV) contractility, which normally changed during dialysis: the plasma concentrations of ionized calcium, potassium, bicarbonate, and magnesium and the removal of uremic toxins. The influence of three different isovolemic bicarbonate-dialysis procedures in 16 patients with normal (group 1) and hypertrophied myocardium (group 2) was assessed by echocardiography prior to and up to 44 h following each dialysis. During the first procedure, ionized calcium and potassium concentration decreased, but LV performance remained unchanged in both groups. The second procedure with increased ionized calcium and decreased potassium concentration resulted in an improvement of mean circumferential fiber shortening (VCF from 1.15 to 1.56 circ/s (P less than 0.001) in group 1 and from 1.05 to 1.16 circ/s (P less than 0.05) in group 2. The positive inotropic effect declined gradually up to 12 h (group 1) and 2.5 h (group 2) respectively. In the third procedure when ionized calcium was increased and potassium concentration remained unchanged contractility did not improve. Removal of uremic toxins, decrease in magnesium, and increase in bicarbonate concentrations were comparable during each procedure. These results suggest that the ionized calcium to potassium ratio is the important determinant of dialysis-related augmentation in LV contractility. In LV hypertrophy the expected contractile response is diminished indicating a depressed inotropic state.

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Rest and Exercise Response of Left Ventricular Functions of Patients on Maintenance Hemodialysis with and without Cornary Artery Disease

Cited by 4 publications

References 0 publications

Effect of Erythropoietin on Ischemia Tolerance in Anemic Hemodialysis Patients with Confirmed Coronary Artery Disease

Effect of Erythropoietin on Ischemia Tolerance in Anemic Hemodialysis Patients with Confirmed Coronary Artery Disease

Cardiac Arrhythmias in End-Stage Renal Disease: Prevalence, Risk Factors, and Management

Mechanisms of altered myocardial contractility during hemodialysis: Importance of changes in the ionized calcium to plasma potassium ratio

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