Evaluation of left ventricular diastolic function in nonhypertensive nondiabetic hemodialysis patients
Yusuf Karavelioğlu1, Sultan Özkurt, Hekim Karapinar
1Department of Cardiology, Çorum Training and Research Hospital, Hitit University, Çorum, Turkey. drcomtr@gmail.com
Insights
Diastolic dysfunction is common in hemodialysis (HD) patients. Even without diabetes mellitus (DM) or hypertension (HT), HD patients exhibit impaired left ventricular (LV) diastolic function, indicating HD itself may be a contributing factor.
Area of Science:
- Cardiology
- Nephrology
- Echocardiography
Background:
- Diastolic dysfunction (DD) is prevalent in hemodialysis (HD) patients.
- The specific causes of DD in HD patients are unclear due to common comorbidities like diabetes mellitus (DM) and hypertension (HT).
Purpose of the Study:
- To investigate left ventricular (LV) diastolic function in HD patients specifically excluding those with DM and HT.
- To determine if DD exists in HD patients independent of common confounding conditions.
Main Methods:
- Echocardiography was used to assess LV systolic and diastolic function in 50 HD patients and 34 healthy controls.
- Patients were analyzed based on the presence or absence of left ventricular hypertrophy (LVH).
Main Results:
- HD patients demonstrated significantly worse diastolic function and increased LV filling pressures compared to controls.
- LV dimensions and systolic function were similar between groups.
- Diastolic function was not significantly different between HD patients with or without LVH, nor between concentric and eccentric hypertrophy types.
Conclusions:
- Hemodialysis is associated with impaired diastolic function, even in the absence of diabetes mellitus and hypertension.
- These findings suggest that the hemodialysis process itself may contribute to diastolic dysfunction in patients.
Aim:
Diastolic dysfunction (DD) is common in hemodialysis (HD) patients. Because diabetes mellitus (DM) and hypertension (HT) are also common in this patient group, the exact reason for DD in HD patients is not clear. The present study evaluated left ventricular (LV) diastolic function in HD patients without DM and HT.
Methods:
Fifty patients on HD and 34 age-matched and sex-matched healthy control individuals were enrolled. Echocardiography was performed in all participants. LV systolic and diastolic functions were evaluated by B-mode echocardiography, pulsed wave, and tissue Doppler imaging. The HD patients were divided into two groups according to the presence or absence of left ventricular hypertrophy (LVH) in echocardiography.
Results:
LV dimensions and systolic function were within normal limits and similar between groups. However, the HD patients had significantly worse diastolic function (E/A: 0.78 ± 0.26 vs. 1.19 ± 0.28, P < 0.001, e'/a' septal: 0.77 ± 0.36 vs. 1.04 ± 0.21, P < 0.001) and increased filling pressure (E/e': 8.55 ± 3.2 vs. 5.79 ± 1.93, P < 0.001). Thirty-one (62%) patients had LVH, whereas 19 (38%) patients did not have LVH. LV systolic and diastolic functions were similar in HD patients with and without LVH. Seventeen (55%) hypertrophies were concentric and 14 (45%) were eccentric. Diastolic functions were similar in patients with either concentric or eccentric hypertrophy.
Conclusion:
Diastolic function is impaired in HD patients even in the absence of diseases that can cause DD such as HT and DM.
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