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[Influence of preload reduction on Tei index and other Doppler echocardiographic parameters of left ventricular
Silvio Henrique Barberato1, Roberto Pecoits Filho
1Centro de Ciências Biológicas e da Saúde, Universidade Católica do Paraná, Curitiba, PR. silviohb@cardiol.br
Insights
Hemodialysis significantly impacts cardiac function, increasing the Tei index and altering mitral inflow Doppler parameters due to preload reduction. Diastolic function remained stable, while systolic velocities indicated improved performance.
Area of Science:
- Cardiology
- Nephrology
- Echocardiography
Context:
- Hemodialysis is a critical treatment for end-stage renal disease.
- Fluid overload and cardiac dysfunction are common complications in hemodialysis patients.
- Assessing cardiac function changes during hemodialysis is essential for patient management.
Purpose:
- To evaluate the effect of hemodialysis-induced preload reduction on the Doppler Tei Index of myocardial performance.
- To assess other parameters of cardiac function, including left ventricular systolic and diastolic function, before and after hemodialysis.
Summary:
- Fifteen patients underwent a single hemodialysis session, with significant fluid removal (2.2 +/- 1.1 L).
- The Tei index increased post-hemodialysis due to prolonged isovolumetric relaxation time and ejection time.
- Mitral inflow parameters (E/A ratio) decreased, while mitral annular tissue Doppler diastolic parameters were unaffected. Systolic velocities showed improvement.
Impact:
- Hemodialysis-induced preload changes significantly affect the Tei index and mitral inflow Doppler parameters.
- Mitral annular diastolic tissue Doppler parameters appear resilient to preload alterations.
- Systolic velocities suggest a potential improvement in systolic function post-hemodialysis, warranting further investigation.
Objective:
To assess the influence of preload reduction by hemodialysis on Doppler Tei Index of myocardial performance and other parameters of cardiac function.
Methods:
The Tei index and left ventricular (LV) systolic and diastolic function parameters were estimated, before and after a single hemodialysis session. Only subjects who were in sinus rhythm, without history of coronary artery disease, and no evidence of cardiac valve disease and pericardial effusion were included in the study.
Results:
Fifteen patients (8 men, mean age 53 +/- 14 years) completed the study. After an ultrafiltration of 2.2 +/- 1.1 liters, peak mitral E velocity decreased (p < 0.05) and A velocity remained unchanged (p = ns), resulting in reduction of E/A ratio (p < 0.01). The Tei index increased (from 0.57 +/- 0.07 to 0.65 +/- 0.09, p < 0.01) because of significant prolongations in isovolumetric relaxation time (from 101 +/- 14 to 113 +/- 17 ms, p < 0.01) and ejection time (from 271 +/- 22 to 252 +/- 22, p < 0.05). The isovolumetric contraction time did not vary (p = ns). There was no change in diastolic tissue Doppler parameters, while systolic velocities increased (p < 0.05).
Conclusion:
The Tei index was affected by hemodialysis-induced preload alterations, as well as other mitral inflow Doppler-derived parameters. The diastolic parameters of mitral annulus Doppler tissue were independent of preload, while systolic velocities suggested improved systolic function.
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