Journal Article

Multidirectional myocardial systolic function in hemodialysis patients with preserved left ventricular ejection fraction and different left ventricular geometry

Hong Wang, Jie Liu, Xiao-dan Yao, Juan Li, Yong Yang, Tie-sheng Cao and Bin Yang

in Nephrology Dialysis Transplantation

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

Volume 27, issue 12, pages 4422-4429
Published in print December 2012 | ISSN: 0931-0509
Published online May 2012 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfs090
Multidirectional myocardial systolic function in hemodialysis patients with preserved left ventricular ejection fraction and different left ventricular geometry

Show Summary Details

Preview

Background

Multidirectional myocardial strain analysis can provide mechanistic insight into the ventricular systolic function and pathophysiology. The aim of this study was to assess the multidirectional systolic function of the left ventricle (LV) and its relationship to LV geometry in hemodialysis patients with preserved left ventricular ejection fraction (LVEF).

Methods

A total of 98 end-stage renal disease patients (age 46 ± 10 years, 60% men) with preserved LVEF (≥50%) on a maintenance hemodialysis program and 18 healthy volunteers were enrolled. The patients were divided into non-hypertrophic groups (classified as normal LV geometry and concentric remodeling) and hypertrophy groups (classified as eccentric and concentric hypertrophy) according to their LV geometries assessed from LV mass/height2.7 and relative wall thickness in combination. Multidirectional strain analysis was performed by two-dimensional speckle tracking echocardiography.

Results

Myocardial systolic strain (longitudinal and circumferential) and stress-corrected midwall fraction shorting (sc-MWFS) were lower in the hypertrophy groups compared with non-hypertrophic groups. Longitudinal strain and strain rate were even lower in the concentric hypertrophy group than the eccentric hypertrophy group (−15.5 ± 2.2% versus −17.8 ± 2.6%, P = 0.001; −0.7 ± 0.2 versus −0.9 ± 0.2s-1, P = 0.016). Impaired longitudinal strain correlated with higher LV mass index (LVMI), relative wall thickness, pre-dialysis systolic blood pressure (SBP), calcium–phosphate product and lower sc-MWFS (all P < 0.0001) and weakly correlated with higher interdialytic weight gain (P = 0.004). Using multivariate linear regression, the independent predictors of LV longitudinal strain were pre-dialysis SBP, LVMI, relative wall thickness and sc-MWFS. There were no differences in LVEF and myocardial function in radial direction among all groups.

Conclusions

In hemodialysis patients with LV hypertrophy, myocardial function was impaired not only in longitudinal direction but also in circumferential direction despite preserved LVEF. Low longitudinal strain is related to LV hypertrophy, concentric geometry and pre-dialysis blood pressure.

Keywords: echocardiography; hemodialysis; left ventricle; strain; systolic function

Journal Article.  4619 words.  Illustrated.

Subjects: Nephrology

Full text: subscription required

How to subscribe Recommend to my Librarian

Users without a subscription are not able to see the full content. Please, subscribe or login to access all content.