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[Mitral flow dynamics in patients with hemodialysis: assessment with pulsed Doppler echocardiography]
S Yatabe1, M Hirabayashi, K Ushizima
1Kaizuka Hospital.
Insights
Hemodialysis significantly lowers blood pressure, impacting early diastolic filling dynamics. This study highlights the crucial role of preload in assessing diastolic function during hemodialysis.
Area of Science:
- Cardiology
- Nephrology
- Medical Physiology
Context:
- Hemodialysis (HD) is a vital treatment for end-stage renal disease.
- HD can induce significant hemodynamic changes, including alterations in blood pressure.
- Understanding these changes is crucial for managing cardiovascular complications in HD patients.
Purpose:
- To investigate the effects of hemodialysis on transmitral flow dynamics.
- To assess changes in diastolic function parameters before and after hemodialysis.
- To determine the relationship between hemodynamic changes and diastolic filling.
Summary:
- Fifteen patients undergoing hemodialysis were studied using pulsed Doppler echocardiography.
- After hemodialysis, significant reductions in systolic and diastolic blood pressure were observed, while heart rate remained unchanged.
- Doppler-derived indices of early and atrial filling showed changes, with early diastolic filling demonstrating a positive correlation with peak systolic stress.
Impact:
- The findings underscore that early diastolic filling during hemodialysis is preload-dependent.
- This emphasizes the necessity of considering preload when evaluating diastolic function in patients undergoing hemodialysis.
- Clinical assessment of diastolic function in this population requires careful attention to volume status.
Abstract:
We investigated transmitral flow dynamics before (B) and after (A) hemodialysis (HD). Pulsed Doppler echocardiography was performed in 15 patients (10 males and 6 females, with a mean age of 51) with neither valvular disease nor heart failure. After HD, systolic and diastolic pressure declined significantly to [156 +/- 27----135 +/- 24mmHg (p less than 0.01) and 84 +/- 16----75 +/- 15mmHg (p less than 0.02)] respectively. However, heart rate did not change. Doppler derived indexes were peak early filling velocity (E), peak filling during atrial contribution (A), early filling time velocity integral (IE), atrial time velocity integral (IA), and percent atrial contribution [IA/(IE + IA) x 100] (%A) There was a positive correlation between E and peak systolic stress (r = 0.437, p less than 0.05). Conclusion; In HD, early diastolic filling is dependent on preload. It is necessary to consider preload when diastolic function is assessed.