The Effect of Hemodialysis-related Volume Changes on Left and Right Ventricle and Left Atrial Function in Dialysis Patients: A Speckle Tracking Echocardiography Study.

Abstract

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.