Preload reduction by a single hemodialysis unmasks abnormal left ventricular inflow jet dynamics and early diastolic incoordinate long axis motion in patients on maintenance hemodialysis

Introduction: End stage renal disease presents with multiple clinical and systemic manifestations. The aim of the present study was to identify the early cardiac and other morbidities in end stage renal disease (ESRD) patients who were under maintenance hemodialysis.Methods: This was an observational, prospective study conducted in fifty established ESRD patients of 20 to 74 years under maintenance hemodialysis in Nephrology unit of Shree Birendra Hospital. Clinical examination, laboratory parameters, electrocardiogram and echocardiography findings were used to identify the morbidities. Results: Among all patients enrolled in the study 88.7% had anemia, 64.2 % systolic murmurs, 62.26 % pedal edema, 73.6 % fatiguability, 71.7 % angina, 24.4 % palpitations and 13.2 % had breathlessness on exertion. 62.26% of the patients had hypertension and 13.20 % had diabetes. In the electrocardiogram, prolonged QTc was observed in 10.4%, followed by T wave inversion in 9.4 % and finally low voltage complex comprised 7.6 %. The echocardiogram showed left ventricular diastolic dysfunction in 58.5 %, left ventricular hypertrophy (overall type) 49 % and valvular lesion like mitral regurgitation and tricuspid regurgitation 83 % and 58.5 % respectively. Conclusion: Cardiac co-morbidities are common in patients diagnosed with ESRD on maintenance hemodialysis.

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Prostacyclin reduces "preload" in conscious dogs via a vagal reflex mechanism

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.1987.253.6.h1477 ◽

1987 ◽

Vol 253 (6) ◽

pp. H1477-H1483

Author(s):

D. M. Nganele ◽

T. H. Hintze

Keyword(s):

Heart Rate ◽

Arterial Pressure ◽

Left Ventricular ◽

Vagal Afferents ◽

Conscious Dogs ◽

Reflex Mechanism ◽

Capacitance Vessels ◽

Preload Reduction ◽

Cardiopulmonary Receptors ◽

Electrical Pacing

The purpose of this study was to determine the effects of prostacyclin on left ventricular (LV) preload in conscious dogs. LV end-diastolic diameter (LV EDD) was used as an index of preload. Because prostacyclin reduces arterial pressure, data were sampled when mean arterial pressure, heart rate, and first derivative of LV pressure (dP/dt) had returned to control levels. There was no dose-response relationship in the preload reduction to prostacyclin, the threshold dose being 0.1 microgram/kg. Intravenous prostacyclin (2.0 micrograms/kg) reduced LV EDD 2.9 +/- 0.5% from 36 +/- 2.2 mm, (P less than 0.01). With heart rate held constant (146 +/- 2.5 beats/min) by electrical pacing, prostacyclin still reduced LV EDD by 4.0 +/- 1.0% from 32 +/- 2.5 mm (P less than 0.05). Intravenous administration of arachidonic acid (500 micrograms/kg) gave similar results. The magnitude of the preload response to prostacyclin was similar to that of nitroglycerin (25 micrograms/kg). Prazosin (1 mg/kg) or bilateral cervical vagal section completely abolished the preload response to prostacyclin but not to nitroglycerin. We, therefore, propose a mechanism where prostacyclin activates cardiopulmonary receptors with vagal afferents that results in a withdrawal of peripheral sympathetic tone to capacitance vessels to reduce preload, in contrast to nitroglycerin, whose mechanism of action is most probably a direct effect on capacitance vessels.

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Interdialytic Weight Gain and Its Relation to Outcome among Patients on Maintenance Hemodialysis

QJM ◽

10.1093/qjmed/hcaa052.020 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

M K Ibrahim ◽

O M M Kamal ◽

M S Hassan ◽

M M M Khalifa

Keyword(s):

Weight Gain ◽

Vena Cava ◽

Total Body Weight ◽

Left Ventricular ◽

Morbidity And Mortality ◽

Maintenance Hemodialysis ◽

Interdialytic Weight Gain ◽

Group I ◽

Cardiovascular Morbidity And Mortality ◽

Group Ii

Abstract Introduction The most common cause of mortality among chronic hemodialysis (HD) patients is cardiovascular disease. Hypervolemia is an important risk factor for hypertension and cardiovascular mortality in HD patients that include chronic volume overload and interdialytic weight gain (IDWG).IDWG affects cardiovascular morbidity and mortality Daily fluctuations in extracellular fluid volume might promote cardiac remodeling resulting in left ventricular hypertrophy (LVH) and cardiac fibrosis. Aim of the study to assess interdialytic weight gain and (its relation to morbidity and mortality) among patients on maintenance hemodialysis. Patient and methods 100 ESRD patients on regular hemodialysis included in study in Ain Shams University hospitals in march 2016 and followed up after one year in march 2017. Type of study cohort study Patients were divided into two groups according to interdialytic weight gain (IDWG): Group I (high IDWG) 50 patients with Absolute weight gain 4kg or more. Or relative IDWG more than 3.5% of total body weight. Group II (low IDWG) 50 patients with absolute weight gain less than 3kg Or relative IDWG less than 3.5% of total body weight. Echocardiography (TTE) for all patients at the start of the study and followed up after one year for detecting outcomes included all-cause mortality, cardiovascular mortality, hospitalization for heart failure/volume overload, hospitalization for myocardial infarction, stroke. Results we found that patient with high (IDWG) group II has significantly higher increase in left ventricular mass index (LVMI),inferior vena cava (IVC) diameter and significantly higher decrease in ejection fraction more than low IDWG group I. Conclusions Patients with high IDWG group II at higher risk of increase LVMI, decrease ejection fraction, increase in interventricular septum (IVS), increase in inferior vena cava diameter more than patients of low IDWG group I and has more cardiovascular morbidity and mortality.

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Preload reduction with right ventricular pacing: Effects on left ventricular hemodynamics and contractile pattern

Clinical Cardiology ◽

10.1002/clc.4960030303 ◽

1980 ◽

Vol 3 (3) ◽

pp. 169-177 ◽

Cited By ~ 6

Author(s):

R. I. Hamby ◽

A. Aintablian

Keyword(s):

Right Ventricular ◽

Left Ventricular ◽

Ventricular Pacing ◽

Right Ventricular Pacing ◽

Preload Reduction

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Totally non-invasive pressure-area measurements of left ventricular contractility during non-invasive preload reduction in humans

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(96)80389-5 ◽

1996 ◽

Vol 27 (2) ◽

pp. 49-50

Author(s):

Mustafa Karamanoglu ◽

Diane Falkin ◽

Michael Feneley

Keyword(s):

Left Ventricular ◽

Ventricular Contractility ◽

Left Ventricular Contractility ◽

Non Invasive ◽

Pressure Area ◽

Preload Reduction

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Layer-specific speckle tracking analysis of left ventricular systolic function and synchrony in maintenance hemodialysis patients

BMC Cardiovascular Disorders ◽

10.1186/s12872-019-01324-z ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Chang Liu ◽

Zi-Ning Yan ◽

Li Fan ◽

Jun Huang ◽

Dan Shen ◽

...

Keyword(s):

Speckle Tracking ◽

Circumferential Strain ◽

Systolic Function ◽

Systolic Dysfunction ◽

Normal Subjects ◽

Left Ventricular ◽

Maintenance Hemodialysis ◽

Middle Segment ◽

Basal Segment ◽

Myocardial Layer

Abstract Background This study investigated the value of layer-specific strain analysis by two-dimensional speckle tracking echocardiography (2D-STE) for evaluating left ventricular (LV) systolic function and synchrony in maintenance hemodialysis (MHD) patients. Methods A total of 34 MHD patients and 35 healthy controls were enrolled in this study. Dynamic images were collected at the LV apical long-axis, the four- and two- chamber, and the LV short-axis views at the basal, middle, and apical segments. The layer-specific speckle tracking (LST) technique was used to analyze the longitudinal strain (LS) and circumferential strain (CS) of LV sub-endocardium, mid-myocardium, sub-epicardium, global longitudinal strain (GLS), global circumferential strain (GCS), the LV 17 segment time to peak LS (TTP), and the peak strain dispersion (PSD). The differences in these parameters were compared between control and MHD groups, and the correlation between PSD and each LS parameter was examined. The receiver operator characteristic (ROC) curve was used to evaluate the efficacy of three myocardial layer LS and CS in the assessment of LV systolic dysfunction in MHD patients. Results MHD patients had comparable left ventricular ejection fraction (LVEF), but significantly smaller LV GLS, GCS, and three-layer LS and CS compared to the control group. The three myocardial layer LS of the basal segment, middle segment, and apex segment was significantly reduced in the MHD patients compared to the normal subjects, while the three myocardial layer CS of the basal segment, middle segment, and apex segment was significantly reduced in the MHD patients compared to the normal subjects, except for the sub-endocardium of the middle and apex segment. MHD patients had significantly higher TTP of LV 17 segments and PSD compared to controls, and had delayed peak time in most segments. In addition, PSD of MHD patients was positively correlated with sub-endocardial and mid-myocardial LS and GLS, but not with sub-epicardial LS. The area under the curves (AUCs) of sub-endocardial, mid-myocardial, and sub-epicardial LS in MHD patients were 0.894, 0.852, and 0.870, respectively; the AUCs of sub-epicardial, mid-myocardial, and sub-endocardial CS were 0.852, 0.837, and 0.669, respectively. Conclusions LST may detect early changes of all three-layer LS and CS and PSD in MHD patients, and is therefore a valuable tool to diagnose LV systolic dysfunction in MHD patients.

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