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[Effect of hemodialysis on left-ventricular contractility]
J Górny1, B Mocarska, M Dowgird
1Wojewódzki Szpital Zespolony w Olsztynie.
Polskie Archiwum Medycyny Wewnetrznej
|July 1, 1991
Summary
Hemodialysis improved left ventricular contractility in end-stage renal failure patients with normal left ventricular diameter by reducing afterload. Patients with enlarged ventricles showed varied responses, suggesting potential intrinsic factors impairing contractility.
Area of Science:
- Nephrology
- Cardiology
- Biomedical Engineering
Background:
- End-stage renal failure (ESRF) patients on hemodialysis often exhibit left ventricular (LV) enlargement.
- LV enlargement may result from intrinsic factors (e.g., coronary disease, inflammation) or extrinsic factors (e.g., hypertension, overhydration, anemia, arteriovenous shunt, uremic toxins).
Purpose of the Study:
- To investigate the impact of hemodialysis on left ventricular contractility and afterload in ESRF patients.
- To differentiate between intrinsic and extrinsic factors contributing to LV dysfunction in hemodialysis patients.
Main Methods:
- Echocardiography was used to assess LV diameter, mean velocity of circumferential fibre shortening (mVcf), and ejection fraction (EF) before and after hemodialysis in 43 ESRF patients.
- Patients were categorized into three groups based on LV diameter: normal (A), enlarged before and after dialysis (B), and enlarged only before dialysis (C).
- End-systolic meridional wall stress was calculated as an afterload index. Stress-shortening relations were analyzed to assess contractility.
Main Results:
- Hemodialysis improved LV contractility only in patients with normal LV diameter (Group A) and significant afterload reduction.
- In Groups A and C, the stress-shortening relation improved post-dialysis.
- In Group B, the stress-shortening relation decreased, with two patients showing no mVcf improvement despite reduced stress, suggesting intrinsic contractility impairment.
Conclusions:
- Hemodialysis can improve left ventricular contractility in ESRF patients with normal LV size by reducing afterload.
- LV enlargement in some hemodialysis patients may be linked to intrinsic factors causing impaired contractility, independent of dialysis-induced changes.