Right Ventricular Function Assessment by Speckle Trackingechocardiography in Patients on Regular Hemodialysis With Preserved Left Ventricular Ejection Fraction

Abstract

Aims: To investigate right ventricular function in hemodialysis patients with preserved left ventricular ejection fraction (LVEF) using twodimensional speckle tracking echocardiography.
 Methods: Patients with end-stage kidney disease (ESKD) who were on regular hemodialysis and had preserved LVEF and a group of age- and sex-matched control subjects were recruited for the study in Bach Mai Hospital. All subjects were interviewed and examined comprehensively. Echocardiography was performed in all patients and controls. Right ventricular function was evaluated using conventional and speckletracking echocardiography. Estimate glomerular filtration rate (eGFR) was calculated according to the MDRD GFR equation.
 Results: From 6/2022 to 11/2022, a total of 61 ESKD receiving hemodialysis regularly and 32 controls were evaluated. The mean age of the hemodialysis patients was 51.2±13.8. Men account for 54.1% (33/61). Hemodialysis patients had larger right ventricular diameters, lower RV fractional area change (FAC) and tricuspid annular plane systolic excursion (TAPSE), and decreased S velocities of the tricuspid valve compared to the controls (p<0.05 for all). Systolic pulmonary artery pressure (sPAP) of the hemodialysis group was higher when compared to the controls (p<0.05 for all). Absolute values of right ventricular global strain (RVGS) and right ventricular free wall strain (RVFWS) were significantly lower in the hemodialysis group than in the control (p<0.05 for all). Absolute values of RVGS and RVFWS inversely correlated to LV mass index (r = -0.42, p<0.05 and r=-0.46, p<0.05, respectively) while they positively correlated to eGFR (r = 0.57, p<0.05 and r = 0.59, p<0.05, respectively), hemoglobin level (r = 0.41, p<0.05 and r = 0.43, p<0.05, respectively), RVFAC (r = 0.54, p<0.05 and r = 0.51, p<0.05, respectively).
 Conclusion: Right ventricular function assessed by speckle tracking echocardiography reduced in hemodialysis patients. Right ventricular myocardial strain strongly correlated with glomerular filtration rate, RVFAC, and moderately correlated with hemoglobin level and LV mass index..