Journal Article

A single session of haemodialysis improves left ventricular synchronicity in patients with end-stage renal disease: a pilot tissue synchronization imaging study

Shirley Yumi Hayashi, Astrid Seeberger, Britta Lind, Jacek Nowak, Marcelo Mazza do Nascimento, Bengt Lindholm and Lars-Åke Brodin

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 23, issue 11, pages 3622-3628
Published in print November 2008 | ISSN: 0931-0509
Published online June 2008 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfn311
A single session of haemodialysis improves left ventricular synchronicity in patients with end-stage renal disease: a pilot tissue synchronization imaging study

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Background. Mechanical left ventricular (LV) dyssynchrony impairs cardiac function in patients with heart failure and LV hypertrophy (LVH) and may be a factor contributing to the high incidence of cardiac deaths in patients with end-stage renal disease (ESRD).

Objectives. To evaluate the possible presence of LV dyssynchrony in ESRD patients, and acute effect of haemodialysis (HD) on LV synchronicity using a tailored echocardiographic modality, tissue synchronization imaging (TSI).

Methods. In 13 clinically stable ESRD patients (7 men; 65 ± 10 years) with LVH, echocardiography data were acquired before and after a single HD session for subsequent off-line TSI analysis enabling the retrieval of regional intraventricular systolic delay data. Six basal and six midventricular LV segments were evaluated. Dyssynchrony was defined as a regional difference in time to peak systolic velocity >105 ms.

Results. Before HD, all patients had at least one dyssynchronous LV segment. The percentage of delayed segments correlated positively to LV end-diastolic diameter (r = 0.68, P < 0.05). HD induced a substantial decrease in the percentage of delayed segments from 36 ± 25% to 19 ± 14% (P < 0.01), reduced average maximal mechanical systolic LV delay from 300 ± 89 to 225 ± 116 ms (P < 0.05) and completely normalized LV synchronicity in three patients (23%).

Conclusions. LV dyssynchrony appears to be present frequently in ESRD patients with LVH. The severity of LV dyssynchrony correlates with LV end-diastolic diameter and decreases after a single session of HD suggesting a mechanistic relevance of volume overload and possibly other toxins accumulating in HD patients.

Keywords: end-stage renal disease; haemodialysis; left ventricular hypertrophy; systolic dyssynchrony; tissue synchronization imaging

Journal Article.  4593 words.  Illustrated.

Subjects: Nephrology

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