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Effect of preload reduction by haemodialysis on new indices of diastolic function
Richard J Graham1, John S Gelman, Lesley Donelan
1Centre for Heart and Chest Research, Monash University Department of Medicine, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, Australia.
Insights
Mitral annular early diastolic velocity is a reliable, preload-independent measure of diastolic function. However, propagation velocity of early diastolic filling (Vp) may be affected by preload, showing weak correlation with annular velocities.
Area of Science:
- Cardiology
- Echocardiography
- Renal Medicine
Background:
- Diastolic function assessment relies on indices like mitral annular velocities and propagation velocity of early diastolic filling (Vp).
- These indices are proposed as preload-independent, but their behavior under preload changes requires further investigation.
Purpose of the Study:
- To evaluate the impact of preload reduction via hemodialysis on echocardiographic indices of diastolic function.
- To assess the relationship between mitral annular early diastolic velocities and Vp following preload reduction.
Main Methods:
- Echocardiography was performed on 17 chronic renal failure patients before and after hemodialysis.
- Measurements included mitral annular early diastolic velocities (M-mode, tissue Doppler) and Vp (color M-mode).
- Hemodynamic parameters were assessed to confirm preload reduction.
Main Results:
- Hemodialysis led to significant reductions in weight and left atrial diameter, confirming preload reduction.
- Mitral annular early diastolic velocities showed no significant change post-hemodialysis.
- Vp significantly decreased after hemodialysis, with weak correlations observed between Vp and mitral annular velocities.
Conclusions:
- Mitral annular early diastolic velocity is a preload-independent index for assessing diastolic function.
- Vp may be influenced by preload, and its relationship with mitral annular velocities is weak.
Abstract:
Assessment of mitral annular motion diastolic velocities by M-mode or tissue Doppler imaging and the propagation velocity of early diastolic filling (Vp) by colour M-mode have been proposed as preload-independent indices of diastolic function. The aim of the present study was to determine the effects of preload reduction by haemodialysis on these new echocardiographic indices and to assess the relationship between these indices. The study group comprised 17 patients with chronic renal failure in sinus rhythm with normal left ventricular systolic function who underwent echocardiography 30 min prior to and 30 min following haemodialysis. Following dialysis there were significant reductions in weight (P<0.001), left atrial diameter (P=0.001), the peak Doppler velocity of early diastolic transmitral flow (P=0.005) and the ratio of Doppler velocities of early to late diastolic transmitral flow (P=0.02), consistent with a reduction in intravascular volume. There was no change after dialysis in early diastolic mitral annular velocity using M-mode (P=0.19) or tissue Doppler imaging from either the septal or lateral walls (P=0.88 and P=0.15 respectively), but there was a reduction in Vp after dialysis (55 to 49 cm/s; P=0.04). There were only weak correlations between Vp and the early diastolic mitral annular velocities (r<0.6 for all). We conclude that the assessment of diastolic function by the mitral annular early diastolic velocity appears to be preload-independent, that Vp may be affected by preload and that there is only a weak relationship between Vp and the early diastolic mitral annular velocity.