September 13, 2018Cardiovascular journal of South Africa/Cardiovascular journal of Southern AfricaOpen Access

Left ventricular twist before and after haemodialysis: an analysis using speckle-tracking echocardiography

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Why the study?

Does a single haemodialysis session alter left ventricular twist measured by speckle-tracking echocardiography in CKD patients?

Structured PICO

Does a single haemodialysis session alter left ventricular twist measured by speckle-tracking echocardiography in CKD patients?

Population

26 chronic kidney disease (CKD) patients undergoing haemodialysis and 26 age- and gender-matched healthy subjects.

Intervention

Single haemodialysis session

Comparator

Pre-haemodialysis baseline

Outcome

Left ventricular twist (apical rotation, basal rotation, and net twist) and ejection fraction (EF) measured by speckle-tracking echocardiographysurrogate

Left ventricular twist components are relatively independent of acute haemodynamic load changes during haemodialysis, unlike ejection fraction, suggesting they may be more reliable markers of intrinsic myocardial function in CKD patients.

Implication

Apical rotation reduction may flag early dysfunction in dialysis patients; leaves open twist's clinical role pending larger validation.

Abstract

BACKGROUND: The most commonly used parameter of cardiac function in the chronic kidney disease (CKD) patient is ejection fraction (EF), using transthoracic echocardiography (TTE). EF is a highly load-dependent measurement, which varies considerably in CKD patients undergoing haemodialysis. The aim of this pilot study was to evaluate a novel measure of myocardial function, left ventricular twist, which is defined as the 'wringing action of the heart', using speckletracking echocardiography in CKD patients before and after haemodialysis. METHODS: Twenty-six patients were recruited from the Chris Hani Baragwanath Hospital haemodialysis unit. TTE was performed according to a detailed standardised protocol before and after a single haemodialysis session. Echocardiography was also performed on 26 age- and gendermatched healthy subjects. RESULTS: ; p = 0.01) despite no difference in EF (61.7 ± 6.2 vs 58.8 ± 13; p = 0.68). There were no differences in the components of twist: apical rotation, basal rotation and net twist before and after dialysis, despite an increase in EF (58.8 ± 13.7 vs 61.2 ± 13.6; p = 0.02) following dialysis. CONCLUSION: Unlike EF, the components of twist are relatively independent of changes in haemodynamic load seen during dialysis. The decrease in apical rotation may represent an early marker of cardiac pathology in the late-stage CKD patient.