Effects of dialysis on left ventricular diastolic filling in patients with chronic renal failure. Assessment with radionuclide ventriculography.

To examine the effects of dialysis on left ventricular (LV) filling, gated radionuclide ventriculography was conducted in 15 patients with renal failure before and after dialysis. The LV regional function was assessed by subdividing the LV region of interest into 4 regions from which global and regional time-activity curves and their first-derivative curves were obtained. Early diastolic asynchrony was measured as the sum of the absolute values (total Δt) of the time differences (Δt) between the global peak LV filling rate (PFR) and that for each of the other 3 regions. Dialysis produced an increase in the peak LV ejection rate (PER), heart rate, total Δt and total Δt/diastolic time. It caused a delay or tendency to delay in the time to PFR without significant changes in the PFR either globally or regionally, and the PFR/PER ratio decreased both globally and regionally. These alterations indicated a failure of improvement of the global and regional LV filling, with more asynchronous filling occurring after dialysis despite the increases in PER and, heart rate, both of which are expected to increase PFR and shorten the time to PFR. There was a negative correlation between the change in total Δ t/diastolic time and the change in the PFR/PER ratio (r= -0.62, p<0.01), with a greater increase in asynchrony occurring with the relative greater reduction in the relative global PFR compared with the global PER after dialysis. Dialysis can produce early diastolic asynchronous filling, which will be associated with a failure of improvement of LV filling despite the increases in LV peak ejection rate and the heart rate. Thus, LV filling requires careful attention in patients undergoing dialysis, since the pattern and timing of the filling is altered, and the excessive water removal by dialysis may affect the LV diastolic filling.