scholarly journals P659 Patterns of diastolic dysfunction and correlation with lung ultrasound B-lines among patients with end-stage renal disease

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
C G Ureche ◽  
R Sascau ◽  
S Ailoaei ◽  
L Tapoi ◽  
C Statescu ◽  
...  
Keyword(s):  
Renal Disease ◽  
Diastolic Dysfunction ◽  
End Stage Renal Disease ◽  
Lung Ultrasound ◽  
Doppler Imaging ◽  
Volume Index ◽  
Hydration Status ◽  
Stage Renal Disease ◽  
End Stage ◽  
B Lines

Abstract Background Cardiovascular disease is the leading cause of death among patients with end-stage renal disease (ESRD). The degree of diastolic dysfunction (DD) as assessed by the E/e’ ratio correlates with worsening eGFR and the presence of diastolic dysfunction is an independent predictor of mortality for these patients. Purpose This study aimed to evaluate the patterns of DD in patients with end-stage renal disease not on renal replacement therapy (RRT) and investigate the correlation with lung ultrasound B-lines as an indicator of the hydration status. Methods Population: CKD patients with eGFR <15 ml/min/1.73 m2 referred for echocardiography. According to the ESC recommendations for DD assessment, the following parameters derived from conventional 2D echocardiography, tissue and conventional doppler imaging were used: average E/e’, septal and lateral e’ velocities, tricuspid regurgitation (TR) velocity, left atrial volume index (LAVi), E/A, E wave velocity, EF. Lung B-lines were assessed at the same time by scanning 28 intercostal spaces (IS) on the antero-lateral chest, 2nd-5thIS along with the midaxillary, anterior axillary, midclavicular and parasternal lines. In each IS, the B-lines were counted from 0 = black lung to 10 = white lung. Results 60 patients (41 males) with an eGFR < 15 ml/min/1.73 m2(CKD-EPI) were included (mean eGFR = 8.3 ml/min/1.73 m2). The mean age was 61 (range 19-83) years old and 28.9% were diabetic. The number of B-lines varied between 0 and 80, with a median of 21. Of the 60 patients enrolled, 19 patients (31.6%) had an EF of <50%. All of them had at least grade I DD and an increased LAVi. 41 patients (68.3%) had a preserved EF (pEF) and among these, 33 had diastolic dysfunction (80.4%). Overall, 52 of the 60 patients enrolled (86.6%) had DD (54.5 % grade I, 42.4 % grade II, 3 % grade III). Mean E/e’, lateral and septal e’, LAVi, TR velocity and the grade of DD were independently correlated with the number of B-lines - as assessed by lung ultrasound (p = 0.03, r = 0.34; p = 0.005, r = 0.43; p = 0.01, r = 0.40; p = 0.04, r = 0.32; p = 0.04; r = 0.32 and p = 0.02; r = 0.37 respectively). Additionally, the number of B-lines correlated with eGFR (p = 0.0008; r = 0.51), hemoglobin (Hb) levels (p = 0.03: r = 0.33) and EF (p = 0.0002; r = 0.56). In multiple regression analysis of a model consisting of E/e’, eGFR, Hb and B-lines, the number of B-lines counted for 18% of the variance of E/e’ (R2= .118, p = 0.03, F = 4.833). Conclusions Our study confirms that DD is extremely common among patients with ESRD even in the presence of a pEF. Additionally, we proved for the first time the independent correlation between the number of B-lines as assessed by lung ultrasound and the grade of DD in ESRD patients not yet on RRT. As it correlates with worse prognosis and mortality, further studies are needed to determine whether improving DD in patients with ESRD translates into better outcomes.

Prevalence of Left Ventricular Diastolic Dysfunction by Tissue Doppler Imaging in Patients with End Stage Renal Disease undergoing Regular Dialysis with Preserved Systolic Function

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ahmed A Elkaialy ◽  
Walid M Sallam ◽  
Sameh S Thabet ◽  
Magdy A Gharieb
Keyword(s):  
Renal Disease ◽  
Diastolic Dysfunction ◽  
Tissue Doppler Imaging ◽  
End Stage Renal Disease ◽  
Tissue Doppler ◽  
Left Ventricular ◽  
Doppler Imaging ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Abstract Background Left ventricular hypertrophy (LVH) is the principal myocardial alteration in patients with ESRD due to multiple preload and afterload factors related to hemodialysis leading to left ventricular diastolic dysfunction manifested by signs and symptoms of heart failure with preserved ejection fraction (HFpEF). The use of echocardiography and tissue Doppler imaging is essential to detect diastolic dysfunction in ESRD patients undergoing hemodialysis as the prevalence of diagnosing HFpEF in ESRD patients is under-estimated. Objective To evaluate the possible impact of renal replacement therapy in the form of regular dialysis provided to end stage renal disease patients on left ventricular diastolic function by implementing tissue doppler imaging. Patients and Methods The study included 100 ESRD patients on regular dialysis presenting to the dialysis unit in Ain Shams University Hospitals. The inclusion criterion was end stage renal disease patients with GFR < 15 ml/min/1.73 m2 on regular dialysis for more than 6 months. Excluded patients were those above than 80 yrs old, with hemodynamic instability, arrhythmias, valvular diseases, ischemic conditions, and LV systolic dysfunction. After the hemodialysis session, ECG gated echocardiography was done applying pulsed wave Doppler on mitral valve to detect E/A ratio, continuous wave Doppler on tricuspid valve to calculate TR vmax, and tissue Doppler on lateral mitral annulus to detect e’ and E/e’ ratio. Moreover, left atrial volume index (LAVI) and other standard echocardiographic parameters were measured. Full history and clinical examination including ECG recording was done and blood samples were taken to measure hemoglobin levels. Patients were then stratified according to their diastolic dysfunction grading. Results Seventy eight percent (78%) of the patients showed diastolic dysfunction including 46 % showed grade I diastolic dysfunction, 26 % showed grade II diastolic dysfunction and 6% showed grade III diastolic dysfunction. Hemoglobin levels showed significant negative correlation with E, E/A, E/E’, LAVI and TR Vmax (r = -0.25, -0.37, -0.29, -0.23 and -0.31 with p 0.012, <0 .001, < 0.003, 0.002 & <0 .001 respectively). Multiple regression analysis revealed smoking, DM, Hb, LVPWd, EF, E/A, LAVI and TR Vmax presented the important determinants of diastolic filling (β = -0.16, 0.15, -0.20, -0.27, -0.25, 0.16, 0.39 & 0.27 and p = 0.002, 0.045, < 0.001, 0.022, < 0.001, 0.039, < 0.001 & < 0.001 respectively). Comparing E/A ratio with E/e’ ratio sensitivities revealed E/A ratio was 28.2% while E/e’ ratio was 74.3%. This was statistically significant showing a difference between the two modalities (χ2 = 33.2526 and p = < 0 .0001). Conclusion In ESRD patients, maladaptive events leading to LVH and diastolic dysfunction occur frequently. Thus, early identification and treatment of factors involved in order to prevent this devastating process. Now it seems that TDI and E, E/A and E/E’ parameters are good instruments for the early detection of LVH and diastolic dysfunction as they are important risk factors for cardiovascular morbidity and mortality in CKD. In comparison with the conventional Doppler techniques, tissue Doppler is a vital tool in diagnosing diastolic dysfunction.

Diastolic dysfunction measured by tissue Doppler imaging in children with end-stage renal disease: a report of the RICH-Q study

2013 ◽  
Vol 24 (2) ◽  
pp. 236-244 ◽  
Author(s):  
Nikki J. Schoenmaker ◽  
Irene M. Kuipers ◽  
Johanna H. van der Lee ◽  
Wilma F. Tromp ◽  
Maria van Dyck ◽  
...  
Keyword(s):  
Renal Disease ◽  
Diastolic Dysfunction ◽  
Diastolic Function ◽  
Tissue Doppler Imaging ◽  
End Stage Renal Disease ◽  
Tissue Doppler ◽  
Doppler Imaging ◽  
Stage Renal Disease ◽  
End Stage ◽  
Conventional Echocardiography

AbstractIntroduction:Early detection of cardiovascular disease in children with end-stage renal disease is essential in order to prevent cardiovascular morbidity and mortality in early adulthood. Tissue Doppler imaging has shown to be a promising method to detect and quantify subtle abnormalities in diastolic function. We therefore compared assessment of diastolic function by conventional echocardiography and tissue Doppler imaging.Methods:We performed conventional echocardiography and tissue Doppler imaging in 38 children with end-stage renal disease and 76 healthy controls. We compared outcomes on parameters related to diastolic function (E/a ratio for conventional echocardiography and E/E′ ratio for tissue Doppler imaging) for both groups using multiple linear regression analysis. Diastolic dysfunction was defined as E/a ratio <1 or E/E′ ratio > 95th percentile for age. To assess the intra-observer reproducibility, the coefficient of variation was calculated.Results: Children with end-stage renal disease had on average a lower E/a ratio (p = 0.004) and a higher mitral and septal E/E′ ratio (both p < 0.001) compared with controls. In all, two children with end-stage renal disease (5%) had diastolic dysfunction according to the E/a ratio, 11 according to the mitral E/E′ ratio (29%), and 16 according to the septal E/E′ ratio (42%) compared with none of the controls (p = 0.109, p < 0.001, and p < 0.001, respectively). The coefficients of variation of the mitral (7%) and septal E/E′ ratio (4%) were smaller than the coefficient of variation of the E/a ratio (11%).Conclusions:Tissue Doppler imaging is a more sensitive and reliable method to detect diastolic dysfunction than conventional E/a ratio in children with end-stage renal disease.

scholarly journals Diastolic dysfunction in end-stage renal disease patient: what the ticking clock has told us?

Clinics ◽  
2011 ◽  
Vol 66 (8) ◽  
pp. 1483-1484
Author(s):  
Mustafa Duran ◽  
Aydin Unal ◽  
Mehmet Tugru Inanc ◽  
Fatma Esin ◽  
Yucel Yilmaz ◽  
...  
Keyword(s):  
Renal Disease ◽  
Diastolic Dysfunction ◽  
End Stage Renal Disease ◽  
Disease Patient ◽  
Stage Renal Disease ◽  
End Stage

scholarly journals Use of SD-OCT to Quantitatively Evaluate Peripheral Congestion in Diastolic Dysfunction with a Role Model in Hemodialysis Patients with End-Stage Renal Disease.

2021 ◽  
Author(s):  
Ibrahim Ozdemir ◽  
Süleyman Çağan Efe
Keyword(s):  
Renal Disease ◽  
Diastolic Dysfunction ◽  
Diastolic Function ◽  
End Stage Renal Disease ◽  
Choroidal Thickness ◽  
Group 3 ◽  
Stage Renal Disease ◽  
End Stage ◽  
Group 1 ◽  
The Ideal

Abstract Purpose: There is no practical quantitative tool to assess peripheral congestion in patients with congestive heart failure. In this study, we aimed to evaluate peripheral congestion by measuring choroidal thickness with SD-OCTin patients with end stage renal disease(ESRD). In addition, volume management by hemodialysis (HD) is often difficult in patients with ESRD. Volume overload or hypovolemia may increase morbidity and mortality in long-term HD patients. Therefore, it is important to determine the ideal ultrafiltration rate (UFR) for each patient. Also, we aimed to find a data to help determine the ideal UFR.Methods: Fifty HD patients with ESRD were divided into 3 groups according to diastolic functions. Patients with mild diastolic dysfunction were enrolled in Group1, those with moderate diastolic dysfunction were enrolled in Group 2, and those with severe diastolic dysfunction were enrolled in Group 3. Choroid was used to evaluate peripheral congestion and choroidal thickness (CT) was measured by optical coherence tomography (OCT) before and after HD.Results: The average CT before HD in Group 3 (259.3 ± 7.5 μm ) was significantly higher than in Group 1 (249.6 ± 9.4 μm) (p=0,015). The average CT after HD in Group 3 (224.1 ± 5.2 μm ) was significantly higher than in Group 1 (232.4 ± 9.3 μm) (p=0,033). The mean of DCT was significantly higher in Group 3 than in Group 1 (p< 0.001)Conclusion:DCT was correlated with diastolic function in ESRD patients undergoing HD, and further evaluation of diastolic function before HD may play a role in finding the ideal UFR.

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