Abstract
The left ventricular (LV) diastolic dysfunction, as well as systolic dysfunction, has been considered to play an important role in the pathogenesis of the cardiac failure in chronic hemodialysis (HD) patients.
To determine whether HD patients have impaired LV diastolic performance, we evaluated the LV diastolic function using pulsed Doppler echocardiography in 13 HD patients (HD group: 5 males, 8 females, mean age 55±9 years) and in 6 healthy subjects (control group: 4 males, 2 females, mean age 48±11 years). The transmitral velocity pattern has two wave components: one in the rapid filling phase (R wave) and the other in the late diastolic phase (A wave). The peak rapid filling velocity (R), the peak atrial filling velocity (A), and the ratio of R to A (A/R) were measured from the velocity pattern. Since the transitral velocity pattern is affected by LV diastolic function and the cardiac preload, it was quite important to obtain an accurate parameter for the volume status. For this, we applied a Swan-Ganz thermodilution ejection fraction/volumetric catheter during HD in 5 patients, and the right ventricular end-diastolic volume index (RVEDVI) was calculated using the thermodilution washout curve.
The A/R ratio was significantly higher in the HD group than in the control group (0.90±0.09 vs 1.21±0.30, p<0.01). In the HD group, R was significantly reduced from 43.5±9.9 to 37.0±8.0cm/sec after one session of HD (p<0.01). ΔR was positively correlated with the reduction of body weight. Since RVEDVI showed a higher correlation coefficient with cardiac index than RAP or PCWP in the right ventricular hemodynamic studies, RVEDVI seemed to be the best parameter for the cardiac preload. In HD patients, there was no statistical significance between ΔRVEDVI and ΔR.
These findings suggest that HD patients may show impaired left ventricular diastolic function even if the changes of preload during HD is taken into consideration.
