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[Diastolic dysfunction in patients with chronic kidney failure on a hemodialysis program]
1Departamento de Cardiologia Médico-Cirúrgica Centro Hospitalar do Funchal.
Insights
Pulsed wave Doppler effectively assesses diastolic dysfunction in chronic renal failure patients on hemodialysis. Tissue Doppler identified a pseudonormal mitral inflow pattern in 17% of patients, highlighting its complementary role.
Area of Science:
- Cardiology
- Nephrology
- Medical Imaging
Background:
- Chronic renal failure (CRF) patients on hemodialysis (HD) often develop left ventricular diastolic dysfunction (LVDD).
- Accurate assessment of LVDD is crucial for managing cardiovascular complications in this high-risk population.
Purpose of the Study:
- To compare pulsed wave Doppler and tissue Doppler imaging for assessing isolated LVDD in CRF patients undergoing HD.
- To analyze various ultrasound parameters for LVDD evaluation in this cohort.
Main Methods:
- Echocardiography including pulsed wave Doppler and tissue Doppler imaging was performed on 47 CRF patients on HD.
- Patients were categorized into two groups based on mitral inflow profile (E/A ratio >1 or <1).
- Key parameters analyzed included LV dimensions, LV mass index, E and A wave velocities, E/A ratio, isovolumetric relaxation time (IVRT), and deceleration time (DT).
Main Results:
- Pulsed wave Doppler and tissue Doppler showed significant differences in E wave velocity, E/A ratio, IVRT, and DT between the groups.
- LV hypertrophy was prevalent in nearly all patients.
- Tissue Doppler identified a pseudonormal mitral inflow pattern (E/A <1) in 17% of patients, which was not apparent with standard pulsed wave Doppler alone.
Conclusions:
- Pulsed wave Doppler is a valuable non-invasive tool for assessing global diastolic dysfunction in CRF patients on HD.
- Tissue Doppler imaging provides complementary information, particularly in identifying pseudonormal mitral inflow patterns indicative of more advanced diastolic dysfunction.
Objective:
The aim of this study was to analyse different ultrasound parameters for the assessment of isolated left ventricular diastolic dysfunction (LVDD) in patients with chronic renal failure (CRF) on periodic hemodialysis (HD), comparing pulsed wave Doppler with pulsed tissue Doppler.
Materials And Methods:
Forty-seven patients with CRF on HD (61% were male; mean age was 51.0 +/- 16.5 years, mean HD time--3.7 +/- 3.8 years, 38% had hypertension, 17% had diabetes) were studied by echocardiography (bidimensional, M-Mode, flow pulsed Doppler and tissue Doppler imaging). All patients had symptoms of left heart failure-class II NYHA, were in sinus rhythm and had no symptoms of ischemic heart disease. The presence of abnormal LV regional contractility was the exclusion criteria. According to their mitral inflow profile Doppler characteristics, patients were included in two groups: Group A (E/A > 1; n = 21) and B (E/A < 1; n = 26). We compared: LV dimensions and function, left atrial (LA) dimension. Gaasch index, LV mass index. E and A wave velocities (in flow pulsatile Doppler and tissue Doppler). E/N ratio in tissue Doppler, isovolumetric relaxation time (IVRT) and deceleration time (DT).
Results:
There were no significant differences in the prevalence of age > or = 65 years male sex, hypertension or diabetes between group A and B patients, and almost all patients were on hemodialytic treatment for more than one year (81% vs 85%: NS). LV hypertrophy was present in almost all group A and B patients (A--95% vs B--85.5%; NS). Group A, compared with group B, had a difference in the Gaasch index (2.45 +/- 0.3 vs 2.08 +/- 0.4; p < 0.05), E wave velocity in flow pulsatile Doppler and tissue Doppler (cm/sec) (110 +/- 27 vs 62 +/- 20; p < 0.001 and 41 +/- 15 vs 28.5 +/- 16; p < 0.05), E/A ratio in tissue Doppler (1.3 +/- 0.4 vs 0.8 +/- 0.3; p < 0.001). IVRT (msec) (80.7 +/- 15.2 vs 113.5 +/- 28.3; p < 0.001) and DT (msec) (189.7 +/- 24 vs 278.2 +/- 17.9; p < 0.001). According to the E'/A' ratio in tissue Doppler, group A patients were divided in another two groups: E'/A' > 1 (13/21--62%) and < 1 (8/21--38%) and a significantly longer IVRT (75.8 +/- 9.3 vs 100.9 +/- 3.2; p < 0.001) and DT (178 +/- 15 vs 240 +/- 20; p < 0.001) and a greater LA dimension (37.6 +/- 6.9 vs 44.6 +/- 6.9; p < 0.05) were found.
Conclusions:
Pulsed wave Doppler is the most useful non invasive method for assessment of global diastolic dysfunction. In our study, 17% of the patients had E/A < 1 only in the tissue Doppler study. These patients probably had a pseudonormal mitral pattern.