Sensitive Detection of Myocardial Contraction Abnormality in Chronic Hemodialysis Patients by Ultrasonic Tissue Characterization with Integrated Backscatter

Abstract

Since acoustic properties of the myocardium are sensitive to the myocardial structure and the contractile conditions of myocyte, the authors evaluated cardiac dysfunction based on the integrated ultrasonic backscatter in 18 hemodialysis (HD) patients (duration: 102 +/- 84 months, mean age: 57.6 +/- 9.7 years) and 11 age-matched normals. The cyclic variation of integrated backscatter (CV-IB) at interventricular septum (IVS) and left ventricular posterior wall (PW) was measured and compared with percent fractional shortening (%FS) and percent wall thickening (%Th). The CV-IB of HD patients was smaller than that of control subjects (IVS: 6.2 +/- 1.1 dB vs 8.2 +/- 1.1 dB, p = 0.0003 and PW: 8.4 +/- 2.2 vs 10.3 +/- 1.3, p= 0.025). No significant difference was observed in %FS and %Th between HD patients and control subjects. In HD, the ratio of velocities of early diastolic inflow (E) to late atrial inflow was decreased (0.7 +/- 0.2 vs 1.1 +/- 0.7, p = 0.049) and deceleration time of E was prolonged significantly (200 +/- 28 msec vs 159 +/- 30 msec, p = 0.0082). In the absence of overt cardiac systolic dysfunction, myocardial damage indicated as a decrease in CV-IB and diastolic dysfunction identified on transmitral velocity waveform were detected, which may reflect from the myocardial fibrosis. As a mechanism, pressure overload, hyperparathyroidism, and anemia were neglected, and the other humoral factors may contribute to the myocardial damage in chronic renal failure.

Dynamic assessment of myocardial involvement in patients with end‐stage renal disease by ultrasonic tissue characterization and serum markers of collagen metabolism

“…7,44 On the other hand, it is possible that the interstitial edema reduces the magnitude of CV-IBS by its effect on myocardial function, since the edema might cause myocardial dysfunction and the magnitude of CV-IBS is directly reflected by the changes in myofibrillar length. 33,45 In the present study, however, the parameter of systolic function (%FS) was not altered by HD in spite of the significant improvement in diastolic function (E/A and DT). It is likely that the improvement of interstitial edema per se is responsible for the decrease in CV-IBS after HD.…”

“…5,6 Mizushige et al suggested that myocardial damages without cardiac systolic dysfunction were identified as a decrease in CV-IBS, which may reflect myocardial fibrosis in patients in chronic HD. 33 In the present study, the group with ESRD showed significantly higher percentage of eccentric LV hypertrophy, lower CV-IBS of the ventricular septum, and impairment of ventricular diastolic function than the group with HTN at comparable LV systolic function and wall thickening. We concluded from the noninvasive technique using echocar-diography that interstitial fibrosis plays a definite role in the development of LV hypertrophy in patients with ESRD.…”

Myocardial Ultrasound Tissue Characterization in Patients with Chronic Renal Failure

“…Mizushige et al (31) observed a reduction in IBS CV in 18 patients who were undergoing HD in comparison with 11 normotensive control subjects; however, the significant difference in LVMI between groups could have influenced the results. In another study, Akar et al (32) observed a reduction in IBS CV in patients with ESRD, in comparison with both normotensive control subjects and patients with EH with normal renal function.…”

Parameters derived by ultrasonic myocardial characterization in dialysis patients are associated with mortality

“…Using a quantitative approach, other researchers were able to confirm in dialysis patients a peculiar echo pattern as compared to normal controls or hypertensive subjects with normal renal function [22,23]. Present study was designed for the specific purpose of ascertaining whether echocardiographic tissue analysis can capture in vivo differences in the hypertrophic myocardium between hypertensives with normal kidney function and uremics in hemodialytic treatment, and whether the ultrasonic alterations in the hypertrophic uremic myocardium are independent risk factors for survival.…”

“…It has been suggested that echocardiographic tissue analysis may be clinically useful in various types of cardiac pathology [13][14][15][16][17], including uremic cardiopathy [18][19][20][21][22][23][24][25][26].…”