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Abnormal diastolic left ventricular filling by pulsed Doppler echocardiography in patients on continuous ambulatory
J Hüting1, W Kramer, J Reitinger
1Center of Internal Medicine, Justus-Liebig University, Giessen, Germany.
Insights
Continuous ambulatory peritoneal dialysis (CAPD) patients show impaired diastolic left ventricular (LV) function. Advanced age exacerbates diastolic dysfunction in hypertrophied LV myocardium among CAPD patients.
Area of Science:
- Cardiology
- Nephrology
- Medical Imaging
Background:
- Diastolic left ventricular (LV) dysfunction is a concern in patients undergoing continuous ambulatory peritoneal dialysis (CAPD).
- Understanding the impact of CAPD on LV diastolic function, particularly in the presence of LV hypertrophy, is crucial for patient management.
Purpose of the Study:
- To characterize diastolic LV function in CAPD patients.
- To compare diastolic LV function between CAPD patients with and without LV hypertrophy and with non-renal hypertensive patients with LV hypertrophy.
Main Methods:
- Doppler-echocardiography was used to assess diastolic LV function.
- Three groups were studied: CAPD patients without LV hypertrophy (n=23), CAPD patients with LV hypertrophy (n=25), and non-renal hypertensive patients with LV hypertrophy (n=11).
- Key Doppler parameters including filling velocities and ratios were analyzed.
Main Results:
- CAPD patients exhibited impaired diastolic LV filling compared to non-renal hypertensive controls.
- Both normal and hypertrophied myocardium in CAPD patients showed diastolic dysfunction.
- High patient age was identified as a factor worsening diastolic dysfunction in hypertrophied LV myocardium.
Conclusions:
- Continuous ambulatory peritoneal dialysis is associated with impaired diastolic left ventricular filling.
- Diastolic dysfunction occurs in both normal and hypertrophied myocardium in CAPD patients.
- Advanced age significantly contributes to diastolic dysfunction in hypertrophied left ventricles of CAPD patients.
Abstract:
To determine characteristics of diastolic left ventricular (LV) function in patients on continuous ambulatory peritoneal dialysis (CAPD), two groups of CAPD patients without (n = 23; group 1) vs with (n = 25; group 2) LV hypertrophy (greater than 13 mm) were compared with a group of untreated non-renal hypertensive patients with LV hypertrophy (n = 11; group 3) using Doppler-echocardiography. Age and body surface area were comparable in all three groups, mean CAPD-duration (32 +/- 28 vs 26 +/- 23 months; p = NS) was comparable in renal patients. LV systolic function in echocardiography (LVEF: 62 vs 64 vs 63%) and systolic time intervals were normal and comparable in all three groups. Atrial maximum filling velocities (96 +/- 25 vs 91 +/- 25 vs 67 +/- 8 cm/s) were comparably increased, the ratio of maximal early/atrial filling velocities was comparably decreased (0.73 +/- 0.25 vs 0.77 +/- 0.21 vs 0.99 +/- 0.05) in both groups of renal patients as compared to group 3 (p less than 0.05-0.01). Atrial filling fractions were increased in all three groups, more pronounced in group 1 than in group 3 (50 +/- 11 vs 40 +/- 7%; p less than 0.05). The normal correlation of Doppler parameters with age and with LV radius/thickness ratio was altered in renal patients such that high patient age tended to have an additional negative influence on LV diastolic function of hypertrophied, but not of normal myocardium. Isovolumic relaxation time was prolonged in all three groups (134 +/- 38 vs 131 +/- 34 vs 116 +/- 17 ms; p = NS). We conclude that in patients on CAPD, diastolic LV filling is impaired both in normal and hypertrophied myocardium. High age is a factor that further attributes to diastolic dysfunction of hypertrophied myocardium in CAPD.