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[Doppler echocardiographic study of left ventricular diastolic function in hemodialysis patients]
A Ben Khalfallah1, L Ghodhbane, R Tlili
1Service de cardiologie, hôpital De Menzel Bourguiba, Tunisie. benkhalfallah@planet.tn
Insights
Diastolic dysfunction is prevalent in 86% of hemodialysis patients. Key Doppler echocardiography parameters like isovolumic relaxation time and flow propagation velocity (Vp) effectively identify different diastolic dysfunction patterns.
Area of Science:
- Cardiology
- Nephrology
- Diagnostic Imaging
Background:
- Hemodialysis patients frequently develop left ventricular diastolic dysfunction.
- Understanding diastolic dysfunction patterns is crucial for managing cardiovascular risk in this population.
Purpose of the Study:
- To investigate the characteristics of diastolic dysfunction in hemodialysis patients.
- To identify echocardiographic parameters with the highest ability to discriminate between different diastolic dysfunction patterns.
Main Methods:
- Conventional Doppler echocardiography was used to assess left ventricular diastolic function.
- Parameters included transmitral flow (E/A), color M-mode flow propagation velocity (Vp), and combined indexes (ENp, Ap-Am).
Main Results:
- 86% of 100 hemodialysis patients exhibited diastolic dysfunction.
- Isovolumic relaxation time, E/A, and Vp showed significant discriminating power (p<0.001).
- Vp differentiated normal from abnormal/pseudo-normal patterns, while combined indexes like Ap-Am characterized restrictive patterns.
Conclusions:
- The discriminating value of diastolic function parameters varies across different stages of dysfunction.
- Vp and isovolumic relaxation time are key in distinguishing normal from pseudo-normal diastolic patterns.
- Doppler echocardiography parameters effectively characterize diastolic dysfunction in hemodialysis patients.
Objectives:
The purpose of this study is to examine the diastolic dysfunction particularities in hemodialysis patients and to identify the parameters having the most discriminating power of diastolic dysfunction.
Methods:
Conventional Doppler echocardiography study implies left ventricular diastolic function from Doppler transmitral flow (E/A), color M-mode flow propagation velocity (Vp) and combined indexes: ratio of peak E-wave velocity to Vp (ENp) and difference in duration of pulmonary venous and mitral flow at atrial contraction (Ap-Am).
Results:
Left ventricular diastolic dysfunction is found in 86% of the 100 hemodialysis patients: abnormal relaxation pattern 52%, pseudo-normal pattern 21%, restrictive pattern 13%. Left ventricular hypertrophy is independent of blood pressure (eta2=3.386; p>0.06). Diastolic function pattern has no relation with duration of dialysis treatment (F=2.637, p>0.05) or left ventricular mass (F=4.298, p>0.06). We noted correlations with age for all parameters of transmitral Doppler flow (p<0.01), Vp and systolic fraction except combined indexes (p>0.05). Doppler parameters of which discriminating power is significant (p<0.001) are in deceasing order: isovolumic relaxation time, E/A, Vp, early filling deceleration time, Ap-Am, E/VP and systolic fraction. The parameter Vp discriminates normal filling from abnormal or pseudo-normal patterns. However it doesn't allow any discrimination between abnormal and pseudo-normal patterns or abnormal and restrictive patterns. Discriminating analysis classify correctly 100% of pseudo normal pattern patients with 2 variables (isovolumic relaxation time and Vp or VP with E/Vp). Factor analysis suggests that Vp characterizes normal pattern and E/A ratio and Ap-Am characterize restrictive pattern.
Conclusion:
Parameters of diastolic function discriminating value is different from one stage to another. VP characterizes normal pattern, combined indexes restrictive pattern. Vp and isovolumic relaxation time discriminates normal from pseudo-normal pattern.
