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Updated: Aug 21, 2026
Evaluation of Left Ventricular Structure and Function using 3D Echocardiography
Published on: October 28, 2020
The Effect of Hemodialysis-related Volume Changes on Left and Right Ventricle and Left Atrial Function in Dialysis
Aysenur Ceylan Isler1, Cansin Tulunay Kaya2, Muge Akbulut2
1Department of Nephrology, School of Medicine, Ankara University, Ankara, Turkey.
Insights
Hemodialysis (HD) negatively impacts myocardial strain in both ventricles and the left atrium, as shown by echocardiography. However, specific diastolic strain parameters remained unchanged, suggesting they are less dependent on cardiac preload.
Area of Science:
- Cardiology
- Nephrology
- Echocardiography
Background:
- The acute effects of hemodialysis (HD) on myocardial function remain debated, despite advancements in echocardiographic techniques.
- This study investigates the immediate impact of HD on cardiac function using novel imaging indices.
Purpose of the Study:
- To evaluate the acute changes in myocardial function following a hemodialysis session.
- To assess the impact of HD on various echocardiographic parameters, including strain and diastolic function.
Main Methods:
- One hundred and four patients on chronic hemodialysis were studied before and after a HD session.
- Tissue Doppler and 2D speckle tracking echocardiography (2DSTE) were employed to assess myocardial function.
Main Results:
- Hemodialysis led to significant decreases in mitral and tricuspid inflow velocities and annular excursion.
- Global longitudinal strain (GLS) and atrial strain parameters showed significant worsening after HD.
- Diastolic strain rate parameters (DSRE, DSRA) and their ratios (E/DSRE, E/DSRA) did not change significantly post-HD.
Conclusions:
- Hemodialysis adversely affects ventricular and atrial strain, indicating a worsening of myocardial function.
- The stability of DSRE and DSRA suggests these indices may be less sensitive to volume and preload changes during hemodialysis.
Background:
The acute effect of hemodialysis (HD) on myocardial function is still controversial, even with the use of new echocardiographic indices. This study is designed to evaluate these acute changes after HD.
Materials And Methods:
One hundred and four patients receiving standard thrice-weekly HD for more than 6 months were examined just before and after a HD session with tissue Doppler and two-dimensional speckle tracking echocardiography (2DSTE).
Results:
Mitral E, mitral A, mitral E/A, medial e', average E/e', tricuspid E, tricuspid E/A, tricuspid e', tricuspid a', and tricuspid annular plane systolic excursion showed significant decreases after HD. The increase in mitral deceleration time, medial myocardial performance index (MPI), and tricuspid MPI after HD was significant. We observed statistically significant changes in global longitudinal strain (GLS)-left ventricular, GLS-right ventricular (RV), free wall strain (FWS)-RV, left atrial reservoir strain, and left atrial conduit strain after HD (P = 0.000, P = 0.000, P = 0.000, P = 0.03, and P = 0.002, respectively). None of the diastolic parameters studied before and after HD, like diastolic strain rate during early diastole (DSRE), diastolic strain rate during atrial diastole (DSRA), E/DSRE, and E/DSRA, changed significantly (P = 0.716, P = 0.117, P = 0.114, and P = 0.211, respectively).
Conclusion:
HD has a worsening effect on strain values of both ventricles and the left atrium. It was interesting that DSRE, DSRA, E/DSRE, and E/DSRA HD were parameters which did not change after HD. This observation with 2DSTE may show that DSRE and DSRA are less volume and cardiac preload-dependent indices.
