Key result
A single session of haemodialysis decreased the percentage of delayed left ventricular segments from 36% to 19% (P<0.01) in patients with end-stage renal disease and LV hypertrophy.
Why the study?
Does a single session of haemodialysis improve left ventricular synchronicity in patients with end-stage renal disease and left ventricular hypertrophy?
Observational (n=13)
Does a single session of haemodialysis improve left ventricular synchronicity in patients with end-stage renal disease and left ventricular hypertrophy?
Absolute Event Rate: 19% vs 36%
p-value: p=<0.01
A single session of haemodialysis acutely improves left ventricular dyssynchrony in patients with end-stage renal disease and left ventricular hypertrophy, likely due to volume reduction.
Acute HD may reduce LV dyssynchrony in ESRD; pilot data leave open clinical relevance and need for larger trials.
BACKGROUND: Mechanical left ventricular (LV) dyssynchrony impairs cardiac function in patients with heart failure and LV hypertrophy (LVH) and may be a factor contributing to the high incidence of cardiac deaths in patients with end-stage renal disease (ESRD). Objectives. To evaluate the possible presence of LV dyssynchrony in ESRD patients, and acute effect of haemodialysis (HD) on LV synchronicity using a tailored echocardiographic modality, tissue synchronization imaging (TSI). METHODS: In 13 clinically stable ESRD patients (7 men; 65 +/- 10 years) with LVH, echocardiography data were acquired before and after a single HD session for subsequent off-line TSI analysis enabling the retrieval of regional intraventricular systolic delay data. Six basal and six midventricular LV segments were evaluated. Dyssynchrony was defined as a regional difference in time to peak systolic velocity >105 ms. RESULTS: Before HD, all patients had at least one dyssynchronous LV segment. The percentage of delayed segments correlated positively to LV end-diastolic diameter (r = 0.68, P < 0.05). HD induced a substantial decrease in the percentage of delayed segments from 36 +/- 25% to 19 +/- 14% (P < 0.01), reduced average maximal mechanical systolic LV delay from 300 +/- 89 to 225 +/- 116 ms (P < 0.05) and completely normalized LV synchronicity in three patients (23%). CONCLUSIONS: LV dyssynchrony appears to be present frequently in ESRD patients with LVH. The severity of LV dyssynchrony correlates with LV end-diastolic diameter and decreases after a single session of HD suggesting a mechanistic relevance of volume overload and possibly other toxins accumulating in HD patients.
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Hayashi et al. (2008) conducted an observational in End-stage renal disease with left ventricular hypertrophy (n=13). Single session of haemodialysis vs. Before haemodialysis (baseline) was evaluated on Percentage of delayed left ventricular segments (p=<0.01). A single session of haemodialysis decreased the percentage of delayed left ventricular segments from 36% to 19% (P<0.01) in patients with end-stage renal disease and LV hypertrophy.