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Heart Failure II: Pathophysiology

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Updated: Jun 22, 2026

Echocardiographic Assessment Using Subxiphoid-Only Examination for Hypotensive Patients

Echocardiographic Assessment Using Subxiphoid-Only Examination for Hypotensive Patients

Published on: April 18, 2025

Left-ventricular diastolic dysfunction as a risk factor for dialytic hypotension.

Guy Rostoker¹, Mireille Griuncelli, Christelle Loridon

¹Division of Nephrology and Dialysis, Centre Hospitalier Privé Claude Galien, Quincy-sous-Sénart, France. rostotom@orange.fr

|June 13, 2009

Summary

Diastolic dysfunction is linked to intradialytic hypotension in hemodialysis patients. A low diastolic flow propagation velocity (Vp) can predict these hypotensive episodes.

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Last Updated: Jun 22, 2026

Echocardiographic Assessment Using Subxiphoid-Only Examination for Hypotensive Patients

Echocardiographic Assessment Using Subxiphoid-Only Examination for Hypotensive Patients

Published on: April 18, 2025

Area of Science:

Nephrology
Cardiology
Internal Medicine

Background:

Intradialytic hypotension (IDH) negatively impacts hemodialysis patient outcomes and survival.
Understanding the relationship between cardiac function and IDH is crucial for improving patient care.

Purpose of the Study:

To investigate the association between left-ventricular diastolic dysfunction and the occurrence of dialytic hypotension.
To identify potential echocardiographic predictors of IDH.

Main Methods:

A prospective cross-sectional study involving 72 hemodialysis patients with low dialysis vintage.
Echocardiography and brain natriuretic peptide (BNP) assays were used to assess cardiac function.
Patients were categorized into normotensive and hypotensive groups.

Main Results:

No significant differences in BNP levels or systolic function parameters (cardiac index, ejection fraction, fractional shortening) were found between groups.
A high prevalence (89-91%) of diastolic dysfunction, indicated by an abnormal E/A ratio, was observed in hypotension-prone patients.
Diastolic flow propagation velocity (Vp) was significantly reduced in hypotensive patients, with a Vp cutoff of 39.5 cm/s optimally predicting IDH.

Conclusions:

Diastolic dysfunction is significantly associated with intradialytic hypotension in hemodialysis patients.
A low Vp, a preload-independent measure, serves as a valuable predictor of dialytic hypotension.