Key result
Hemodialysis associated with a ~7% drop in left atrial reservoir and conduit strain in ESRD.
Why the study?
The study sought to evaluate left atrial strain parameters before and after dialysis using 2D-STI and explore the effect of volume load changes on left atrial function in maintenance hemodialysis patients.
Does hemodialysis alter left atrial strain parameters in patients with end-stage renal disease?
Observational (n=106)
Does hemodialysis alter left atrial strain parameters in patients with end-stage renal disease?
Absolute Event Rate: 26% vs 28%
p-value: p=.003
Left atrial strain parameters measured by 2D-STI can quantitatively evaluate the changes in left atrial function due to volume load reduction during hemodialysis in ESRD patients.
Acute LA strain shifts with dialysis volume load in MHD patients are hypothesis-generating; leaves open whether 2D-STI refines ultrafiltration or risk stratification.
OBJECTIVE: We sought to evaluate the left atrial (LA) strain parameters of maintenance hemodialysis (MHD) patients before and after dialysis by two dimensional speckle tracking imaging (2D-STI), and to explore the effect of volume load change on LA function. METHODS: Seventy-six patients with end stage renal disease (ESRD) on hemodialysis (HD) were enrolled in the study protocol. The median duration of dialysis was 24.0 (7.5, 59.5) months. In addition, 30 healthy subjects were selected as control group. Comprehensive echocardiography was performed immediately before and after hemodialysis to compare the changes in left atrial function. RESULTS: Regarding LA strain parameters in patients of pre-HD, the median (25th, 75th) LA reservoir, LA conduit, and LA contractile reserve were 28.0 (23.0, 34.5), -15.5 (-10.0, -21.5), -12.0 (-9.0, -16.0) respectively; the post-HD were 26.0 (21.0, 29.0), -12.0 (-9, -15.5), -12.5 (-9, -15.5) respectively; and controls were 43.0 (36.0, 48.0), -24.0 (-18.0, -32.0), -17.0 (-15.0, -22.0) respectively. The left atrial strain parameters before HD were lower than controls, the differences were statistically significant, the p-value were .000, .025, and .000, respectively. The reservoir function and conduit function of LA strain decreased after hemodialysis, the differences were statistically significant, the p-value were .003 and .006, respectively. Regarding the contraction of LA, the differences between pre- and post-HD were not statistically significant (p = .965). CONCLUSION: Hemodialysis removes excess water in human body, while LVGLS and Doppler parameters are greatly affected by reduced preload. New echocardiographic parameters, such as left atrial strain, can quantitatively evaluate the changes in left atrial function before and after hemodialysis in ESRD patients, which can provide valuable information for the overall cardiac evaluation in this specific population.
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Miao et al. (2024) conducted an observational in End-stage renal disease (n=106). Hemodialysis vs. Pre-hemodialysis state was evaluated on Left atrial reservoir strain (p=.003). Hemodialysis significantly decreased left atrial reservoir strain (median 28.0 to 26.0, p=0.003) and conduit strain in patients with end-stage renal disease.
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