The impact of volume overload on right heart function in end‐stage renal disease patients on hemodialysis

Ünlü, Serkan; Şahinarslan, Asife; Gökalp, Gökhan; Seçkin, Özden; ARINSOY, Selim Turgay; Boyacı, Nuri Bülent; Çengel, Atiye

doi:10.1111/echo.13768

Cited by 12 publications

(5 citation statements)

References 48 publications

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“…Stated otherwise, a decrease in the LA volume is in tandem with a reduction in the LA conduit function. Concerning the RA, in patients with end-stage renal disease, the RA volume and conduit function decrease after hemodialysis, which is compatible with the aforementioned study regarding the LA (39). It can, therefore, be explained why the inter-study difference vis-a-vis the RA volume index may lead to an inter-study difference in terms of the RA conduit function.…”

Section: The Conduit Functionsupporting

confidence: 85%

Normal Ranges of Right Atrial Strain and Strain Rate by Two-Dimensional Speckle-Tracking Echocardiography: A Systematic Review and Meta-Analysis

Hosseinsabet

Mahmoudian

Jalali

et al. 2021

Front. Cardiovasc. Med.

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Background: Normal range values of right atrial (RA) phasic function markers are essential for the identification of normal and abnormal values, comparison with reference values, and the clinical meaning of obtained values. Accordingly, we aimed to define the normal range values of RA phasic function markers obtained by 2D speckle-tracking echocardiography through a meta-analysis and determine the main sources of heterogeneity among reported values.Methods: PUBMED, SCOPUS, and EMBASE databases were searched for the following keywords: “right atrial/right atrium” and “strain/speckle/deformation” and “echocardiography.” Studies were selected that included a human healthy adult group without any cardiovascular diseases or risk factors and that were written in the English language. For the calculation of each marker of RA phasic functions, a random-effect model was used. Meta-regression was employed to define the major sources of variabilities among reported values.Results: Fifteen studies that included 2,469 healthy subjects were selected for analysis. The normal range values for RA strain and strain rate were 42.7% (95% CI, 39.4 to 45.9%) and 2.1 s−1 (95% CI, 2.0 to 2.1 s−1) during the reservoir phase, respectively, 23.6% (95% CI, 20.7 to 26.6%) and −1.9 s−1 (95% CI, −2.2 to −1.7 s−1) during the conduit phase, correspondingly, and 16.1% (95% CI, 13.6 to 18.6%) and −1.8 s−1 (95% CI, −2.0 to −1.5 s−1) during the contraction phase, respectively. The sources of heterogeneity for the normal range of these markers were the number of participants, the type of software, the method of global value calculation, the right ventricular fractional area change, the left ventricular (LV) ejection fraction, the RA volume index, sex, the heart rate, the diastolic blood pressure, the body mass index, and the body surface area.Conclusions: Using 2D speckle-tracking echocardiography, we defined normal values for RA phasic function markers and identified the sources of heterogeneity as demographic, anthropometric, hemodynamic, and echocardiography factors.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021236578, identifier: CRD42021236578.

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Section: The Conduit Functionsupporting

confidence: 85%

Normal Ranges of Right Atrial Strain and Strain Rate by Two-Dimensional Speckle-Tracking Echocardiography: A Systematic Review and Meta-Analysis

Hosseinsabet

Mahmoudian

Jalali

et al. 2021

Front. Cardiovasc. Med.

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“…Current data support that a mean ultrafiltration rate of >13 mL/kg/h is associated with higher mortality rates in the long term (6-11). The acute effect of rapid ultrafiltration on the cardiac functions has been investigated in some studies (12); however, there is still a lack of data about the exact relationship between acute rapid ultrafiltration and cardiac functions. All previous studies have been limited into studying the impact of HD on peak strain values, and that the potential influence of HD on the temporal characteristics of deformation and especially mechanical dispersion has not been studied until now.…”

Section: Introductionmentioning

confidence: 99%

Higher Ultrafiltration Rate is Associated with Right Ventricular Mechanical Dispersion

Ünlü¹,

Pagourelias

Sezenöz

et al. 2019

Anatol J Cardiol

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Higher ultrafiltration rate is associated with right ventricular mechanical dispersion Objective: Ultrafiltration rate is one of the major determinants of adverse outcomes in patients undergoing hemodialysis (HD) therapy. Previous studies have focused on the impact of HD on right ventricular (RV) peak strain values. However, the influence of HD on the temporal characteristics of deformation has not been reported yet. The aim of the present study was to evaluate the impact of high ultrafiltration rate (HUR) on RV mechanical dyssynchrony. Methods: Echocardiographic images focused on the RV and left ventricle (LV) were obtained from 60 patients (49.2±17.3 years, 22 female) before and after HD. Patients were divided into two groups according to ultrafiltration rate. Changes in echocardiographic parameters with HD were examined. Two-dimensional speckle-tracking strain analysis was used to assess deformation. Mechanical dispersion was measured as the standard deviation of time to peak longitudinal strain of six segments for RV and 18 segments for LV. Results: The average ultrafiltrated volume and ultrafiltration rate were 3000.1±1007.9 mL and 11.4±2.9 mL/kg/h, respectively. Global longitudinal strain (GLS) of the RV and LV decreased after HD in both groups. A significant difference was observed in RV mechanical dispersion with HD for patients in the high ultrafiltration group. A mild statistically insignificant increase in LV mechanical dispersion was also observed after HD. Conclusion: HUR has a substantial impact on LV and RV GLS and RV dyssynchrony. Ultrafiltration rates and volumes should be kept as low as possible to achieve hemodynamic stability and tolerability.

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“…Although strain is considered independent of loading conditions, some studies reported a bettering in strain values ensuing elective HD within minutes or days [ 23 ]. We believe that the amelioration seen in all studied parameters at 6 months after HD initiation is a milestone in the life of an ESKD patient.…”

Section: Discussionmentioning

confidence: 99%

Right Ventricular Functionality Following Hemodialysis Initiation in End-Stage Kidney Disease—A Single-Center, Prospective, Cohort Study

et al. 2021

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Background and Objectives: Two-dimensional speckle tracking echocardiography (2D-STE) is viewed as an outstanding technique, competent of uncovering earlier subclinical myocardial anomalies compared to conventional echocardiography. A few endeavors adopted 2D-STE as a tool to estimate right ventricular (RV) function in subjects with end-stage kidney disease (ESKD). There is no published prospective study on an adult ESKD cohort exploring the consequences of commencing elective hemodialysis (HD) on RV behavior. Materials and Methods: We investigated the RV systolic function using traditional (tricuspid annular plane systolic excursion—TAPSE, RV fractional area change—FAC) and 2D-STE (RV free wall longitudinal strain—RVFWLS) parameters following the initiation of HD. We enrolled 79 consecutive patients with ESKD and assessed them in four steps—at baseline, before HD, and at 3, 6, and 12 months. Results: RVFWLS, FAC, and TAPSE values had a significant increase at 3, 6, and 12 months from baseline (p < 0.001) and a significant increase at 6 months from 3 months (p < 0.001). However, differences between 12 months and 6 months were not significant (p > 0.05) according to Dunn–Bonferroni post hoc tests. Seventeen deaths were recorded before the completion of the study. RVFWLS, FAC, and TAPSE values significantly decreased at 3 and 6 months in all 17 deceased patients, in clear opposition with the values survivors had. All the studied parameters had a significant prediction power on mortality (p < 0.001) having an outstanding performance: baseline-RVFWLS (AUC: 1.000 (95% C.I.: 1.000–1.000)), baseline-FAC (AUC: 0.974 (95% C.I.: 0.942–1.000)), and baseline-TAPSE (AUC: 0.962 (95% C.I.: 0.920–1.000). Conclusions: Our study is the first to investigate RV function by 2D-STE and correlate it with traditional methods in patients with ESKD before and after the initiation of HD. RV function was significantly ameliorated at 3, 6, and 12 months compared to the pre-HD values. FAC and RVFWLS gain an outstanding prognostic role on mortality in this population.

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The impact of volume overload on right heart function in end‐stage renal disease patients on hemodialysis

Cited by 12 publications

References 48 publications

Normal Ranges of Right Atrial Strain and Strain Rate by Two-Dimensional Speckle-Tracking Echocardiography: A Systematic Review and Meta-Analysis

Normal Ranges of Right Atrial Strain and Strain Rate by Two-Dimensional Speckle-Tracking Echocardiography: A Systematic Review and Meta-Analysis

Higher Ultrafiltration Rate is Associated with Right Ventricular Mechanical Dispersion

Right Ventricular Functionality Following Hemodialysis Initiation in End-Stage Kidney Disease—A Single-Center, Prospective, Cohort Study

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