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The presystolic wave was not sufficient for diagnosing subclinical left ventricular diastolic dysfunction in hemodialysis patients

Year 2019, Volume: 44 Issue: Supplement 1, 529 - 538, 29.12.2019
https://doi.org/10.17826/cumj.623583

Abstract

Purpose: In hemodialysis patients, detection of left ventricul diastolic dysfunction as early as possible is critically important. The presystolic wave occurs in the left ventricul outflow tract and it’s associated with left ventricul stiffness and compliance. The aim of this study was to evaluate the clinical significance of presystolic wave in the detection of diastolic dysfunction in hemodialysis patients. 

Materials and Methods: In this cross-sectional study, eighty hemodialysis patients and 88 healthy controls were included in the study. The laboratory parameters were tested before the dialysis. The conventional B-mode, pulsed doppler parameters, doppler tissue-imaging, and presystolic wave measurements were performed at echocardiography. 

Results: Presystolic wave was detected in 46.0% of patients and 18.1% of the control group. There was no statistically significant difference between patients in terms of MPI, mitral E and A wave velocity, E/A and e’/a’ ratio, deceleration time, septal a’ and e’ wave velocity, and Sao in either presence or absence of presystolic wave. In the univariate model, higher Eao velocity and septal E/e’ ratio, and reduced duration of hemodialysis were determined as risk factors for the presence of presystolic wave.

Conclusion: The assessment of presystolic wave on echocardiography examination may provide important information about the left ventricul diastolic function. But we have demonstrated in this study that presystolic wave is not entirely associated with left ventricul diastolic dysfunction in hemodialysis patients. 


References

  • 1. Cheung AK, Sarnak MJ, Yan G, Dwyer JT, Heyka RJ, Rocco MV et al. Atherosclerotic cardiovascular disease risks in chronic hemodialysis patients. Kidney Int. 2000;58:353-362.
  • 2. Burton JO, Jefferies HJ, Selby NM, McIntyre CW. Hemodialysis-induced repetitive myocardial injury results in global and segmental reduction in systolic cardiac function. Clin J Am Soc Nephrol. 2009;4:1925-1931.
  • 3. Henry RM, Kostense PJ, Bos G, Dekker JM, Nijpels G, Heine RJ et al. Mild renal insufficiency is associated with increased cardiovascular mortality: the Hoorn Study. Kidney Int. 2002;62:1402–1407.
  • 4. Bonow R, Udelson J: Left ventricular diastolic dysfunction as a cause of congestive heart failure: mechanism and management. Ann Intern Med. 1992;117:502–510.
  • 5. Melenovsky V, Hwang SJ, Redfield MM, Zakeri R, Lin G, Borlaug BA. Left atrial remodeling and function in advanced heart failure with preserved or reduced ejection fraction. Circ Heart Fail. 2015;8:295–303
  • 6. Hartog JW, Hummel YM, Voors AA, Schalkwijk CG, Miyata T, Huisman RM et al. Skin-autofluorescence, a measure of tissue advanced glycation end-products (AGEs), is related to diastolic function in dialysis patients. J Card Fail. 2008;14:596-602.
  • 7. Tavil Y, Kaya MG, Sen N, Tacoy G, Okyay K, Yazici HU et al. Assessment of left ventricular systolic and diastolic function by tissue Doppler analysis in patients with hypertension with or without hyperuricemia. Blood Press Monit. 2008;13:79–84.
  • 8. Periyasamy SM, Chen J, Cooney D, Carter P, Omran E, Tian J et al. Effects of uremic serum on isolated cardiac myocyte calcium cycling and contractile function. Kidney Int. 2001;60:2367-2376.
  • 9. London GM, Marchais SJ, Guerin AP, Metivier F, Adda H. Arterial structure and function in end-stage renal disease. Nephrol Dial Transplant. 2002;17:1713-1724.
  • 10. Bryg RJ , Williams GA, Lobovitz AJ. Effect of aging on left ventricular diastolic filling in normal subjects. Am J Cardiol. 1987;59:971–974.
  • 11. Mittal SR, Pancholi N. Left ventricular outflow tract presystolic flow velocity –another marker of left ventricular diastolic function. Int J Cardiovasc Imaging. 2002;18:249–256.
  • 12. Korkmaz L, Akyüz AR, Gurbak I, Erkan H, Dursun I, Celik S et al. Presystolic A wave may predict increased arterial stiffness in asymptomatic individuals. Blood Press Monit. 2016;21:144–148.
  • 13. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA et al. Chamber Quantification Writing Group, American Society of Echocardiography’s Guidelines and Standards Committee, European Association of Echocardiography. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18:1440–1463
  • 14. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015;16:233–270
  • 15. Nagueh SF, Middleton KJ, Kopelen HA, Zoghbi WA, Quiñones MA. Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures. J Am Coll Cardiol. 1997;30:1527-33.
  • 16. Park JH, Marwick TH. Use and Limitations of E/e' to Assess Left Ventricular Filling Pressure by Echocardiography. J Cardiovasc Ultrasound. 2011;19:169-73.
  • 17. Tei C, Ling LH, Hodge DO, Bailey KR, Oh JK, Rodeheffer RJ et al. New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function - a study in normals and dilated cardiomyopathy. J Cardiol. 1995;26:357-366
  • 18. Armstrong WF, Ryan T, Feigenbaum H. Feigenbaum’s Echocardiography. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2010, p. 545.
  • 19. Joshi KR, Kabirdas D, Romero-Corral A, Shah M, Figueredo VM, Pressman GS. Clinical significance of a presystolic wave on Doppler examination of the left ventricular outflow tract. Am J Cardiol. 2014;114:1599–1602
  • 20. Panayiotou H, Byrd BF 3rd. Origin and significance of diastolic Doppler flow signals in the left ventricular outflow tract. J Am Coll Cardiol. 1990;16:1625–1631.
  • 21. Paulus W, Tschope C, Sanderson J, Rusconi C, Flachskampf F, Rademakers FE et al. How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Association of the European Society of Cardiology. Eur Heart J. 2007;28:2539–2550.
  • 22. Appleton CP, Hatle LK, Popp RL. Relation of transmitral flow velocity patterns to left ventricular diastolic function: new insights from a combined hemodynamic and Doppler echocardiographic study. J Am Coll Cardiol. 1988;12:426e440.
  • 23. Kim YH, Park DW, Kim WJ, Lee JY, Yun SC, Kang SJ, Lee SW et al. Validation of SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) score for prediction of outcomes after unprotected left main coronary revascularization. J Am Coll Cardiol Interv. 2010;3:612–623
  • 24. Havlucu Y, Kursat S, Ekmekci C, Celik P, Serter S, Bayturan O, Dinc G. Pulmonary hypertension in patients with chronic renal failure. Respiration. 2007;74:503–510.
  • 25. Appleton CP, Firstenberg MS, Garcia MJ, Thomas JD. The echodoppler evaluation of left ventricular diastolic function. Cardiol clin. 2000;18: 513–546.
  • 26. Quin˜ones MA , Otto CM, Stoddard M, Waggoner A, Zoghbi WA. Recommendations for quantification of Doppler echocardiography: a report from the Doppler Quantification Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography. J Am Soc Echocardiogr. 2002;15:167–184.
  • 27. Kuwahara M, Iimori S, Kuyama T, Akita W, Mori Y, Asai T et al. Effect of anemia on cardiac disorders in pre-dialysis patients immediately before starting hemodialysis. Clin Exp Nephrol. 2011;15:121–125.
  • 28. Galetta F, Cupisti A, Franzoni F, Femia FR, Rossi M, Barsotti G, Santoro G. Left ventricular function and calcium phosphate plasma levels in uraemic patients. J Intern Med. 2005;258:378-384.
  • 29. Abbasnezhad M, Tayyebi-Khosroshahi H, Ghanbarpour A, Habibzadeh A. Is There any Time Dependant Echocardiographical Finding in Chronic Hemodialysis Patients ? Cardiol Res. 2012;3:271-276.
  • 30. Suh SY, Kim EJ, Choi CU, Na JO, Kim SH, Kim HJ et al. Aortic upper wall tissue Doppler image velocity: relation to aortic elasticity and left ventricular diastolic function. Echocardiography. 2009;26:1069-74.
  • 31. Rostand SG, Drueke TB. Parathyroid hormone, vitamin D, and cardiovascular disease in chronic renal failure. Kidney Int. 1999;56:383-392.
  • 32. Galetta F, Cupisti A, Franzoni F, Carpi A, Barsotti G, Santoro G. Acute effects of hemodialysis on left ventricular function evaluated by tissue Doppler imaging. Biomed Pharmacother. 2006;60:66-70.
  • 33. Dincer I, Kumbasar D, Nergisoglu G, Atmaca Y, Kutlay S, Akyurek O et al. Assessment of left ventricular diastolic function with Doppler tissue imaging: effects of preload and place of measurements. Int J Cardiovasc Imaging. 2002;18:155-160.

Hemodiyaliz hastalarında subklinik sol ventrikül diyastolik disfonksiyonu tanısında prestostolik dalga yetersiz kalmıştır

Year 2019, Volume: 44 Issue: Supplement 1, 529 - 538, 29.12.2019
https://doi.org/10.17826/cumj.623583

Abstract

Amaç: Hemodiyaliz hastalarında, sol ventrikül diyastolik fonksiyon bozukluğunun mümkün olduğu kadar erken saptanması kritik öneme sahiptir. Presistolik dalga sol ventrikül çıkış yolunda saptanmaktadır ve sol ventrikül sertliği ve uyumu ile ilişkilidir. Bu çalışmanın amacı, hemodiyaliz hastalarında presistolik dalganın diyastolik fonksiyon bozukluğunun saptanmasında yardımcı olup olamayacağını değerlendirmektir.

Gereç ve Yöntem: Bu kesitsel çalışmada, 80 hemodiyaliz hastası ve 88 sağlıklı kontrol çalışmaya dahil edildi. Laboratuvar parametreleri diyalizden önce test edildi. Ekokardiyografide konvansiyonel B mod, darbeli doppler parametreleri, doppler doku görüntüleme ve presistolik dalga ölçümleri yapıldı.

Bulgular: Presistolik dalga hastaların % 46.0'sında ve kontrol grubunun % 18.1'inde tespit edildi. Hastalarda miyokard performans indeksi, mitral E ve A dalga hızı, E / A ve e '/ a' oranı, deselerasyon zamanı, septal a' ve e' dalga hızı ve Sao açısından presistolik dalga olan ve olmayan arasında istatistiksel olarak anlamlı fark yoktu. Univariate analiz sonucunda, yüksek Eao hızı ve septal E / e ’oranı ve kısa hemodiyaliz süresi presistolik dalga varlığı için risk faktörü olarak belirlendi.

Sonuç: Ekokardiyografik olarak presistolik dalganın değerlendirilmesi sol ventrikül diyastolik fonksiyonu hakkında önemli bilgiler sağlayabilir. Ancak çalışmamızda presistolik dalganın hemodiyaliz hastalarında sol ventrikül diyastolik fonksiyon bozukluğu ile ilişkili olmadığını gösterdik. 


References

  • 1. Cheung AK, Sarnak MJ, Yan G, Dwyer JT, Heyka RJ, Rocco MV et al. Atherosclerotic cardiovascular disease risks in chronic hemodialysis patients. Kidney Int. 2000;58:353-362.
  • 2. Burton JO, Jefferies HJ, Selby NM, McIntyre CW. Hemodialysis-induced repetitive myocardial injury results in global and segmental reduction in systolic cardiac function. Clin J Am Soc Nephrol. 2009;4:1925-1931.
  • 3. Henry RM, Kostense PJ, Bos G, Dekker JM, Nijpels G, Heine RJ et al. Mild renal insufficiency is associated with increased cardiovascular mortality: the Hoorn Study. Kidney Int. 2002;62:1402–1407.
  • 4. Bonow R, Udelson J: Left ventricular diastolic dysfunction as a cause of congestive heart failure: mechanism and management. Ann Intern Med. 1992;117:502–510.
  • 5. Melenovsky V, Hwang SJ, Redfield MM, Zakeri R, Lin G, Borlaug BA. Left atrial remodeling and function in advanced heart failure with preserved or reduced ejection fraction. Circ Heart Fail. 2015;8:295–303
  • 6. Hartog JW, Hummel YM, Voors AA, Schalkwijk CG, Miyata T, Huisman RM et al. Skin-autofluorescence, a measure of tissue advanced glycation end-products (AGEs), is related to diastolic function in dialysis patients. J Card Fail. 2008;14:596-602.
  • 7. Tavil Y, Kaya MG, Sen N, Tacoy G, Okyay K, Yazici HU et al. Assessment of left ventricular systolic and diastolic function by tissue Doppler analysis in patients with hypertension with or without hyperuricemia. Blood Press Monit. 2008;13:79–84.
  • 8. Periyasamy SM, Chen J, Cooney D, Carter P, Omran E, Tian J et al. Effects of uremic serum on isolated cardiac myocyte calcium cycling and contractile function. Kidney Int. 2001;60:2367-2376.
  • 9. London GM, Marchais SJ, Guerin AP, Metivier F, Adda H. Arterial structure and function in end-stage renal disease. Nephrol Dial Transplant. 2002;17:1713-1724.
  • 10. Bryg RJ , Williams GA, Lobovitz AJ. Effect of aging on left ventricular diastolic filling in normal subjects. Am J Cardiol. 1987;59:971–974.
  • 11. Mittal SR, Pancholi N. Left ventricular outflow tract presystolic flow velocity –another marker of left ventricular diastolic function. Int J Cardiovasc Imaging. 2002;18:249–256.
  • 12. Korkmaz L, Akyüz AR, Gurbak I, Erkan H, Dursun I, Celik S et al. Presystolic A wave may predict increased arterial stiffness in asymptomatic individuals. Blood Press Monit. 2016;21:144–148.
  • 13. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA et al. Chamber Quantification Writing Group, American Society of Echocardiography’s Guidelines and Standards Committee, European Association of Echocardiography. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18:1440–1463
  • 14. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015;16:233–270
  • 15. Nagueh SF, Middleton KJ, Kopelen HA, Zoghbi WA, Quiñones MA. Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures. J Am Coll Cardiol. 1997;30:1527-33.
  • 16. Park JH, Marwick TH. Use and Limitations of E/e' to Assess Left Ventricular Filling Pressure by Echocardiography. J Cardiovasc Ultrasound. 2011;19:169-73.
  • 17. Tei C, Ling LH, Hodge DO, Bailey KR, Oh JK, Rodeheffer RJ et al. New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function - a study in normals and dilated cardiomyopathy. J Cardiol. 1995;26:357-366
  • 18. Armstrong WF, Ryan T, Feigenbaum H. Feigenbaum’s Echocardiography. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2010, p. 545.
  • 19. Joshi KR, Kabirdas D, Romero-Corral A, Shah M, Figueredo VM, Pressman GS. Clinical significance of a presystolic wave on Doppler examination of the left ventricular outflow tract. Am J Cardiol. 2014;114:1599–1602
  • 20. Panayiotou H, Byrd BF 3rd. Origin and significance of diastolic Doppler flow signals in the left ventricular outflow tract. J Am Coll Cardiol. 1990;16:1625–1631.
  • 21. Paulus W, Tschope C, Sanderson J, Rusconi C, Flachskampf F, Rademakers FE et al. How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Association of the European Society of Cardiology. Eur Heart J. 2007;28:2539–2550.
  • 22. Appleton CP, Hatle LK, Popp RL. Relation of transmitral flow velocity patterns to left ventricular diastolic function: new insights from a combined hemodynamic and Doppler echocardiographic study. J Am Coll Cardiol. 1988;12:426e440.
  • 23. Kim YH, Park DW, Kim WJ, Lee JY, Yun SC, Kang SJ, Lee SW et al. Validation of SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) score for prediction of outcomes after unprotected left main coronary revascularization. J Am Coll Cardiol Interv. 2010;3:612–623
  • 24. Havlucu Y, Kursat S, Ekmekci C, Celik P, Serter S, Bayturan O, Dinc G. Pulmonary hypertension in patients with chronic renal failure. Respiration. 2007;74:503–510.
  • 25. Appleton CP, Firstenberg MS, Garcia MJ, Thomas JD. The echodoppler evaluation of left ventricular diastolic function. Cardiol clin. 2000;18: 513–546.
  • 26. Quin˜ones MA , Otto CM, Stoddard M, Waggoner A, Zoghbi WA. Recommendations for quantification of Doppler echocardiography: a report from the Doppler Quantification Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography. J Am Soc Echocardiogr. 2002;15:167–184.
  • 27. Kuwahara M, Iimori S, Kuyama T, Akita W, Mori Y, Asai T et al. Effect of anemia on cardiac disorders in pre-dialysis patients immediately before starting hemodialysis. Clin Exp Nephrol. 2011;15:121–125.
  • 28. Galetta F, Cupisti A, Franzoni F, Femia FR, Rossi M, Barsotti G, Santoro G. Left ventricular function and calcium phosphate plasma levels in uraemic patients. J Intern Med. 2005;258:378-384.
  • 29. Abbasnezhad M, Tayyebi-Khosroshahi H, Ghanbarpour A, Habibzadeh A. Is There any Time Dependant Echocardiographical Finding in Chronic Hemodialysis Patients ? Cardiol Res. 2012;3:271-276.
  • 30. Suh SY, Kim EJ, Choi CU, Na JO, Kim SH, Kim HJ et al. Aortic upper wall tissue Doppler image velocity: relation to aortic elasticity and left ventricular diastolic function. Echocardiography. 2009;26:1069-74.
  • 31. Rostand SG, Drueke TB. Parathyroid hormone, vitamin D, and cardiovascular disease in chronic renal failure. Kidney Int. 1999;56:383-392.
  • 32. Galetta F, Cupisti A, Franzoni F, Carpi A, Barsotti G, Santoro G. Acute effects of hemodialysis on left ventricular function evaluated by tissue Doppler imaging. Biomed Pharmacother. 2006;60:66-70.
  • 33. Dincer I, Kumbasar D, Nergisoglu G, Atmaca Y, Kutlay S, Akyurek O et al. Assessment of left ventricular diastolic function with Doppler tissue imaging: effects of preload and place of measurements. Int J Cardiovasc Imaging. 2002;18:155-160.
There are 33 citations in total.

Details

Primary Language English
Subjects Cardiovascular Surgery
Journal Section Research
Authors

Çağlar Özmen 0000-0002-7285-991X

Bülent Kaya 0000-0003-4697-4815

Rabia Eker Akıllı 0000-0003-4922-6556

Ömer Tepe 0000-0002-6734-7311

Ali Deniz 0000-0001-5539-2863

Mehmet Kanadaşı This is me 0000-0003-3635-7426

Mesut Demir This is me 0000-0003-3775-8969

Ayhan Usal This is me 0000-0003-2579-4858

Publication Date December 29, 2019
Acceptance Date October 8, 2019
Published in Issue Year 2019 Volume: 44 Issue: Supplement 1

Cite

MLA Özmen, Çağlar et al. “The Presystolic Wave Was Not Sufficient for Diagnosing Subclinical Left Ventricular Diastolic Dysfunction in Hemodialysis Patients”. Cukurova Medical Journal, vol. 44, 2019, pp. 529-38, doi:10.17826/cumj.623583.