e-Περιοδικό Επιστήμης & Τεχνολογίας
(EL)
Left ventricular (LV) diastolic function has been causally deteriorated on hypotensive
episodes during hemodialysis (ΗD). The influence of intravascular volume
deterioration and arterial pressure reduction on LV function in patients without
hypotensive episodes during ΗD has not been adequately studied. 23 patients on ΗD
were studied for 48±35 months, whose mean age was 50±12 years, their mean body
mass index was 24±4kg/m2
and their mean fluid retention between ΗD sessions
2.2±1.1 kgr. We used 2D and Doppler echocardiography before and after the same
HD session. The following parameters were measured: a) end-diastolic (LVED) and
end-systolic LV diameters, left atrial diameter (LA) and fraction shortening (FS) b)
isovolumic relaxation (IVRT) and contraction (ICT) time, deceleration time (DT), Ε
and Α waves of the mitral inflow and ejection time (ΕΤ) of the LV outflow velocity.
The following indices were calculated: E/A ratio, myocardial performance index
(ΜΡΙ) using the (IVRT+ICT)/ET formula, mean arterial pressure (ΜΑΡ), the %
reduction in ΜΑΡ and the reduction in intravascular volume after HD. Stroke volume
(SV) and corresponding cardiac output (CO), were calculated from the LV outflow
velocity waveform. All patients demonstrated systolic arterial pressure at the level of
≥90mmHg and normal FS before ΗD, while they had demonstrated restrictive LV
diastolic filling before ΗD. ΜΑΡ, SV, CO, LVΕD, LΑ, Ε wave and Ε/Α decreased
while IVRT increased after ΗD (p<0.01). After HD, low ΜΡΙ values (normal range
<0.44) were related to greater ultrafiltration volume loss (UFV) (r=0.53, p<0.01) and
greater % reduction in ΜΑΡ (r=0.62, p<0.01). Conversely, abnormal ΜΡΙ values were
related to high ΜΑΡ after ΗD (r=0,44, p<0.01). Increased UFV was related to greater
% increase in IVRT (r=0.43, p<0.01) and % decrease in Ε/Α (r=0.40, p<0.01) after
HD. Patients with UFV >3kg (7/23) had lower ΜΡΙ (0.47±0.2 vs. 0.84±0.3, p<0.01)
and greater % increase in ΙVRT and % reduction in Ε/Α (p<0.01 ) than those with
<3kgr. Fluid retention between ΗD sessions leads to restrictive LV diastolic filling as
shown by an Ε/Α>1 and a short IVRT in patients before HD. Reduction in the excess
intravascular volume after ΗD normalises ΜΑΡ and thus, improves LV performance.
(EN)
e-Journal of Science & Technology
(EN)
