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Load-independent parameters of diastolic and systolic function by speckle tracking and tissue doppler in hemodialysis

Lígia Mendes1, Regina Ribeiras, Teresa Adragão

  • 1Serviço de Cardiologia, Hospital de Santa Cruz, Carnaxide, Portugal. ligiamendes76@gmail.com

Revista Portuguesa De Cardiologia : Orgao Oficial Da Sociedade Portuguesa De Cardiologia = Portuguese Journal of Cardiology : an Official Journal of the Portuguese Society of Cardiology
|December 3, 2008
PubMed

Insights

New echocardiographic methods show that E/Em ratios are load-independent for assessing diastolic function in end-stage renal disease patients undergoing hemodialysis. Systolic function parameters also remained load-independent, with similar results across different imaging techniques.

Area of Science:

  • Cardiology
  • Nephrology
  • Medical Imaging

Background:

  • Conventional Doppler echocardiography for diastolic function assessment is limited by volume load dependency.
  • The load-independence of novel echocardiographic methods for evaluating left ventricular systolic and diastolic function remains debated.

Purpose of the Study:

  • To identify load-independent echocardiographic parameters for systolic and diastolic function in end-stage renal disease (ESRD) patients undergoing hemodialysis (HD).
  • To evaluate the agreement between new echocardiographic methods for assessing cardiac function in ESRD patients.

Main Methods:

  • 20 stable ESRD patients undergoing HD had echocardiograms before and after dialysis.
  • Parameters assessed included left ventricular volumes, ejection fraction, transmitral Doppler flow (E/A), mitral annular velocities (Em, Am) via pulsed tissue Doppler imaging (TDI), and strain via color TDI and speckle tracking imaging (STI).
  • E/Em and Am/Em ratios were calculated using spectral Doppler, pulsed TDI, color TDI, and STI.

Main Results:

  • Hemodialysis led to significant decreases in left atrial and ventricular volumes and transmitral flow.
  • Early diastolic myocardial velocities (Em) significantly decreased post-HD, indicating volume load dependency.
  • Systolic function parameters, including ejection fraction and myocardial velocities/strain, remained unchanged and appeared load-independent.
  • E/Em ratios were also found to be load-independent.

Conclusions:

  • Early diastolic myocardial velocity (Em) is volume load-dependent in ESRD patients undergoing HD.
  • E/Em ratios and systolic function parameters are load-independent, offering reliable assessment despite volume status changes.
  • Pulsed TDI, color TDI, and STI provide consistent results for evaluating myocardial systolic and diastolic function.
Abstract

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