scholarly journals Echocardiographic assessment of cardiac dysfunction in maintenance hemodialysis patients

2017 ◽  
Vol 5 (2) ◽  
pp. 97-100
Author(s):  
Md Zahid Alam ◽  
Mohammad Zakir Hossain
Keyword(s):  
Wall Motion ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Regional Wall Motion ◽  
Left Ventricular ◽  
Maintenance Hemodialysis ◽  
Ventricular Systolic Dysfunction ◽  
Before And After ◽  
Stage Renal Disease ◽  
End Stage

Background and Objectives: The hemodialysis (HD) procedure may acutely induce regional left ventricular systolic dysfunction. This study evaluated the echocardiographic parameters in patients with End Stage Renal Disease (ESRD) on HD and to correlate those with clinical findings, more specifically to see whether there is any change in ejection fraction (EF) by developing new regional wall motion abnormality (RWMA) after hemodialysis, and to correlate these changes with the symptoms & hemodynamic condition of the patients.Methodology: This prospective observational study was carried on a total of 100 adult ambulant patients with end stage renal disease (ESRD) on maintenance hemodialysis in the department of Hemodialysis, BIRDEM General Hospital, Shahbag, Dhaka. Their echocardiogram was done 30 min before and after the hemodialysis.Result: It was revealed that majority of the patients were above 60 years (39%), and male to female ratio of about 3:2. The study subjects had diabetes mellitus (79%), hypertension (96%), dyslipidemia (42%), and family history of ischemic heart disease (24%). Chest pain and breathlessness were present in 31% and 42% subjects respectively before hemodialysis. Palpitation (23%), dizziness (19%), oedema (43%) and raised JVP (15%) were seen in the study subjects. Mean (±SD) serum creatinine level was 9.38 (±2.22) mg/dl and hemoglobin level was 9.0 (±1.08) g/dl. Ejection fraction (EF) before hemodialysis were ?55, 40-54 & 30-39 in 62%, 34% and 4% study subjects respectively and after hemodialysis it was ?55, 40-54 & 30-39 in 44%, 46% and 10% study subjects respectively. After HD, left ventricular failure (LVF) occurred in 32% subjects. HD-induced regional left ventricular systolic dysfunction occurred in total 36 patients (36%) and total 14 (14%) patients developed LVF 30 minutes after dialysis. Patients with hemodialysis-induced left ventricular systolic dysfunction were more in those who had worse predialysis EF. Blood pressure, heart rate, chest pain, palpitation, raised Jugular Venous Pressure (JVP) and edema did not differ significantly before and after hemodialysis. Simple regression analysis revealed that the hemodialysis procedure significantly (P<0.05) induce regional left ventricular systolic dysfunction.Conclusions: HD acutely induces regional wall motion abnormalities in a significant proportion of patients. It occurs within 30 min after hemodialysis and is not related to changes in blood pressure, heart rate, JVP and oedema.Bangladesh Crit Care J September 2017; 5(2): 97-100

scholarly journals Clinical and Echocardiographic Factors Associated with Right Ventricular Systolic Dysfunction in Hemodialysis Patients

2016 ◽  
Vol 6 (3) ◽  
pp. 230-236
Author(s):  
Juan Manuel López-Quijano ◽  
Antonio Gordillo-Moscoso ◽  
Jesús Antonio Viana-Rojas ◽  
Jorge Carrillo-Calvillo ◽  
Peter B. Mandeville ◽  
...  
Keyword(s):  
Right Ventricular ◽  
End Stage Renal Disease ◽  
Systolic Dysfunction ◽  
Hemodialysis Patients ◽  
Left Ventricular ◽  
Ventricular Systolic Dysfunction ◽  
Factors Associated ◽  
Relaxation Velocity ◽  
Stage Renal Disease ◽  
End Stage

Background: Chronic kidney disease is a disorder of epidemic proportions that impairs cardiac function. Cardiovascular diseases are the leading cause of death in hemodialysis patients, and the understanding of new nontraditional predictors of mortality could improve their outcomes. Right ventricular systolic dysfunction (RVSD) has recently been recognized as a predictor of cardiovascular death in heart failure and hemodialysis patients. However, the factors contributing to RVSD in hemodialysis patients remain unknown. The aim of this study was to evaluate the clinical and echocardiographic factors associated with RVSD in hemodialysis patients. Methods: A cross-sectional study was conducted in which 100 outpatients with end-stage renal disease on chronic hemodialysis were evaluated. A transthoracic echocardiographic examination was performed at optimal dry weight. Right ventricular systolic function was evaluated using tricuspid annular plane systolic excursion (TAPSE). Clinical and echocardiographic data were recorded for each patient. A multivariate linear logistic regression was created using RVSD (TAPSE <14 mm) as the dependent variable. Results: Fifteen patients with RVSD and 85 patients without RVSD were analyzed. TAPSE had a positive correlation with left ventricular ejection fraction (LVEF) and myocardial relaxation velocity. Independent contributors to RVSD were LVEF (OR 1.14, 95% CI 1.05-1.26), left ventricular mass index (OR 1.02, 95% CI 1.00-1.04), and myocardial relaxation velocity (OR 1.81, 95% CI 1.18-3.19). Conclusions: Echocardiographic factors were significant contributors to RVSD. These measurements could be included as part of the routine workup in all end-stage renal disease patients on hemodialysis.

Elevated circulating cardiotrophin-1 in heart failure: relationship with parameters of left ventricular systolic dysfunction

2000 ◽  
Vol 99 (1) ◽  
pp. 83-88 ◽  
Author(s):  
S. TALWAR ◽  
I. B. SQUIRE ◽  
P. F. DOWNIE ◽  
R. J. O'BRIEN ◽  
J. E. DAVIES ◽  
...  
Keyword(s):  
Heart Failure ◽  
Stroke Volume ◽  
Wall Motion ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Function ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Ventricular Systolic Dysfunction ◽  
The Relationship ◽  
Fractional Shortening

Cardiotrophin-1 (CT-1) is a cytokine that has been implicated as a factor involved in myocardial remodelling. The objective of the present study was to establish the relationship between circulating levels of CT-1 and measures of left ventricular size and systolic function in patients with heart failure. We recruited 15 normal subjects [six male; median age 60 years (range 30–79 years)] and 15 patients [11 male; median age 66 years (range 43–84 years)] with a clinical diagnosis of heart failure and echocardiographic left ventricular systolic dysfunction (LVSD). Echocardiographic variables (left ventricular wall motion index, end-diastolic and -systolic volumes, stroke volume, fractional shortening) and plasma CT-1 levels were determined. In patients with LVSD [median wall motion index 0.6 (range 0.3–1.4)], CT-1 was elevated [median 110.4 fmol/ml (range 33–516 fmol/ml)] compared with controls [wall motion index 2 in all cases; median CT-1 level 34.2 fmol/ml (range 6.9–54.1 fmol/ml); P < 0.0001]. Log CT-1 was correlated with log wall motion index (r = -0.76, P < 0.0001), log left ventricular end-systolic volume (r = 0.54, P < 0.05), stroke volume (r = -0.60, P = 0.007) and log fractional shortening (r = -0.70, P = 0.001). In a multivariate model of the predictors of log wall motion index, the only significant predictor was log CT-1 (R2 = 56%, P = 0.006). This is the first assessment of the relationship between plasma CT-1 levels and the degree of LVSD in humans, and demonstrates that CT-1 is elevated in heart failure in relation to the severity of LVSD.

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