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Park EJ, Cho AR, Kim HJ, Lee HJ, Jeon S, Baik J, Do W, Kang C, Kang Y. Preoperative echocardiography as a predictor of spinal anesthesia-induced hypotension in older patients with mild left ventricular diastolic dysfunction: a retrospective observational study. Anesth Pain Med (Seoul) 2024; 19:134-143. [PMID: 38725168 PMCID: PMC11089297 DOI: 10.17085/apm.23161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/21/2024] [Accepted: 03/11/2024] [Indexed: 05/15/2024] Open
Abstract
BACKGROUND Spinal anesthesia-induced hypotension (SAH) frequently occurs in older patients, many of whom have mild left ventricular (LV) diastolic dysfunction, often asymptomatic at rest. This study investigated the association between preoperative echocardiographic measurements and SAH in older patients with mild LV diastolic dysfunction. METHODS We conducted a retrospective observational study using data from electronic medical records. The patients ≥ 65 years old who underwent spinal anesthesia for urologic surgery between January 2016 and December 2017 and whose preoperative echocardiography within 6 months before surgery revealed grade I LV diastolic dysfunction were recruited. SAH was investigated using the anesthesia records. Logistic regression and receiver operating characteristic (ROC) curve analyses were performed. RESULTS A total of 163 patients were analyzed. SAH and significant SAH developed in 55 (33.7%) patients. The mitral inflow E velocity was an independent risk factor for SAH (odds ratio [OR], 0.886; 95% confidence interval [CI], 0.845-0.929; P < 0.001). The area under the ROC curve for mitral inflow E velocity to predict SAH was 0.819 (95% CI, 0.752-0.875; P < 0.001). If mitral inflow E velocity was ≤ 60 cm/s, SAH was predicted with a sensitivity of 83.6% and specificity of 70.4%. CONCLUSIONS The preoperative mitral inflow E velocity demonstrated the greatest predictability of SAH in older patients with mild LV diastolic dysfunction. This may assist in identifying patients at high risk of SAH and guiding preventive strategies in the future.
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Affiliation(s)
- Eun Ji Park
- Department of Anesthesia and Pain Medicine, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Ah-Reum Cho
- Department of Anesthesia and Pain Medicine, Medical Research Institute, Pusan National University Hospital, Busan, Korea
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Korea
| | - Hyae-Jin Kim
- Department of Anesthesia and Pain Medicine, Medical Research Institute, Pusan National University Hospital, Busan, Korea
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Korea
| | - Hyeon-Jeong Lee
- Department of Anesthesia and Pain Medicine, Medical Research Institute, Pusan National University Hospital, Busan, Korea
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Korea
| | - Soeun Jeon
- Department of Anesthesia and Pain Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jiseok Baik
- Department of Anesthesia and Pain Medicine, Medical Research Institute, Pusan National University Hospital, Busan, Korea
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Korea
| | - Wangseok Do
- Department of Anesthesia and Pain Medicine, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Christine Kang
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yerin Kang
- Department of Anesthesia and Pain Medicine, Medical Research Institute, Pusan National University Hospital, Busan, Korea
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Nguyen HTT, Do CV, Dang DTV, Do LD, Doan LH, Dang HTV. Progressive alterations of left atrial and ventricular volume and strain across chronic kidney disease stages: a speckle tracking echocardiography study. Front Cardiovasc Med 2023; 10:1197427. [PMID: 37745120 PMCID: PMC10513786 DOI: 10.3389/fcvm.2023.1197427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/11/2023] [Indexed: 09/26/2023] Open
Abstract
Background It has been a scarcity of evidence regarding differences in left ventricular (LV) and left atrial (LA) size and strain changes across stages of chronic kidney disease (CKD) and which echocardiographic parameters could be utilized to predict the decline of glomerular filtration rate (GFR). Objectives This study aimed to evaluate the alterations of LV and LA strain across the reduction of renal function and potential echocardiographic parameters which could be correlated with the GFR decline among patients with CKD. Method A cross-sectional study was conducted on 169 CKD patients at Bach Mai General Hospital, Hanoi, Vietnam from April to November 2022. Demographic, clinical and laboratory characteristics of patients were collected. Transthoracic echocardiography was performed to measure LV and LA size and strains. Jonckheere-Terpstra test was used to measure the tendency of change. Multivariate linear regression models were performed to find associations between different echocardiographic parameters and renal function reduction. Results The number of patients with CKD stages 1, 2, 3, 4, and 5 was 21 (12.4%), 28 (16.6%), 27 (16.0%), 22 (13.0%) and 71 (42.0%), respectively. CKD severity was positively associated with LV diastolic and systolic diameters, LV mass, E/e' ratio, and maximal tricuspid regurgitation velocity (TR max), and negatively correlated with the LV global longitudinal strain. Higher severity of CKD stage was associated with higher LA diameter, LA strain, and volume in four and two-chamber views, and lower LA reservoir and conduit function. Left ventricular mass (β = 0.068), ejection fraction (β = 0.112) and left atrial reservoir (β = -0.077) were associated with reduced GFR. Conclusion Left ventricular mass, ejection fraction, and atrial longitudinal strain by STE should be done at the earlier stages of CKD patients for better follow-up of GFR decline.
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Affiliation(s)
- Hoai Thi Thu Nguyen
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam
- VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Chien Van Do
- Department of Cardiovascular Intensive Care Unit, 108 Military Central Hospital, Hanoi, Vietnam
| | - Dieu Thi Vu Dang
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam
| | - Loi Doan Do
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam
- Department of Cardiology, Hanoi Medical University, Hanoi, Vietnam
| | - Linh Huu Doan
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam
- VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Ha Thi Viet Dang
- Department of Internal Medicine, Hanoi Medical University, Hanoi, Vietnam
- Center of Nephrology, Urology and Dialysis, Bach Mai Hospital, Hanoi, Vietnam
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3
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Yildirim U, Akcay M, Coksevim M, Turkmen E, Gulel O. Comparison of left atrial deformation parameters between renal transplant and hemodialysis patients. Cardiovasc Ultrasound 2022; 20:5. [PMID: 35216587 PMCID: PMC8881848 DOI: 10.1186/s12947-022-00275-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/17/2022] [Indexed: 11/24/2022] Open
Abstract
Background Renal transplantation (RT) has been demonstrated to improve left ventricular systolic function. However, only few studies have attempted to reveal the effects of transplantation on left atrial (LA) function. In our study, we aimed to compare LA function between RT and hemodialysis patients. Methods This cross-sectional study included 75 consecutive patients with RT, and 75 age- and gender-matched patients on maintenance hemodialysis. LA strain and strain rate (SR) analyzed by two-dimensional (2D) speckle tracking echocardiography (STE) were compared between the groups in addition to standard echocardiographic parameters. Results LA strain during reservoir phase (29.88 ± 5.76% vs 26.11 ± 5.74%, P < .001), LA strain during conduit phase (− 15.28 ± 5.00% vs − 12.92 ± 4.38%, P = .003), and LA strain during contraction phase (− 14.60 ± 3.32% vs − 13.19 ± 3.95%, P = .020) were higher in the transplantation group. Similarly, LA peak SR during reservoir phase (1.54 ± 0.33 s− 1 vs 1.32 ± 0.33 s− 1, P < .001), LA peak SR during conduit phase (− 1.47 ± 0.49 s− 1 vs − 1.12 ± 0.42 s− 1, P < .001), and LA peak SR during contraction phase (− 2.13 ± 0.46 s− 1 vs − 1.83 ± 0.58 s− 1, P = .001) were higher in the transplantation group as well. Conclusions LA function assessed by 2D STE was better in RT patients than hemodialysis patients. This may suggest favorable effects of RT on LA function.
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Affiliation(s)
- Ufuk Yildirim
- Department of Cardiology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey.
| | - Murat Akcay
- Department of Cardiology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Metin Coksevim
- Department of Cardiology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Ercan Turkmen
- Department of Nephrology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Okan Gulel
- Department of Cardiology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
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Kansal N, Garg P, Mathur P, Sharma P, Shrivastava M. Study of the Prevalence of Echocardiographic Abnormalities and Their Relation to Disease Progression in Chronic Kidney Disease. JOURNAL OF THE INDIAN ACADEMY OF ECHOCARDIOGRAPHY & CARDIOVASCULAR IMAGING 2021. [DOI: 10.4103/jiae.jiae_44_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Iyngkaran P, Anavekar NS, Neil C, Thomas L, Hare DL. Shortness of breath in clinical practice: A case for left atrial function and exercise stress testing for a comprehensive diastolic heart failure workup. World J Methodol 2017; 7:117-128. [PMID: 29354484 PMCID: PMC5746665 DOI: 10.5662/wjm.v7.i4.117] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 06/29/2017] [Accepted: 11/22/2017] [Indexed: 02/06/2023] Open
Abstract
The symptom cluster of shortness of breath (SOB) contributes significantly to the outpatient workload of cardiology services. The workup of these patients includes blood chemistry and biomarkers, imaging and functional testing of the heart and lungs. A diagnosis of diastolic heart failure is inferred through the exclusion of systolic abnormalities, a normal pulmonary function test and normal hemoglobin, coupled with diastolic abnormalities on echocardiography. Differentiating confounders such as obesity or deconditioning in a patient with diastolic abnormalities is difficult. While the most recent guidelines provide more avenues for diagnosis, such as incorporating the left atrial size, little emphasis is given to understanding left atrial function, which contributes to at least 25% of diastolic left ventricular filling; additionally, exercise stress testing to elicit symptoms and test the dynamics of diastolic parameters, especially when access to the "gold standard" invasive tests is lacking, presents clinical translational gaps. It is thus important in diastolic heart failure work up to understand left atrial mechanics and the role of exercise testing to build a comprehensive argument for the diagnosis of diastolic heart failure in a patient presenting with SOB.
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Affiliation(s)
- Pupalan Iyngkaran
- Department of Medicine, Northern Territory Medical School, Flinders University, Charles Darwin University Campus, Casuarina, NT 0815, Australia
| | - Nagesh S Anavekar
- Department of Cardiology, Northern Hospital, Northern Health, University of Melbourne, Melbourne, VIC 3076, Australia
| | - Christopher Neil
- Cardiology Unit Western Health, Department of Medicine, Western Precinct, University of Melbourne, Melbourne, VIC 3076, Australia
| | - Liza Thomas
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW 214, Australia
- Westmead Hospital, Westmead Clincal School, University of Sydney, NSW 2145, Australia
| | - David L Hare
- Cardiovascular Research, University of Melbourne, Melbourne, VIC 3076, Australia
- Heart Failure Services, Austin Health, Melbourne, VIC 3084, Australia
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Hwang JH, Park JB, Kim YJ, An JN, Yang J, Ahn C, Jung IM, Lim CS, Kim YS, Kim YH, Lee JP. The prognostic significance of preoperative left ventricular diastolic dysfunction and left atrial enlargement on acute coronary syndrome in kidney transplantation. Oncotarget 2017; 8:71154-71163. [PMID: 29050351 PMCID: PMC5642626 DOI: 10.18632/oncotarget.16862] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 03/28/2017] [Indexed: 01/15/2023] Open
Abstract
Echocardiography is commonly performed as a screening test to evaluate perioperative risks before kidney transplantation. However, only limited data are available on echocardiographic parameters of left ventricular diastolic dysfunction (LVDD) and left atrial enlargement (LAE) on acute coronary syndrome and mortality in kidney transplant recipients. We reviewed 2779 adult recipients who underwent pretransplant echocardiography from 1997 to 2012. We divided the patients into two and four groups by two categories: LVDD grades 0-1 vs. 2-3, and left atrial size quartile groups. During a mean follow-up of 4.5 years, acute coronary syndrome occurred in 89 (3.2%) patients. The recipients with LVDD grades 2-3 (P = 0.005 for non-fatal, P = 0.02 for fatal/non-fatal) and LAE (P = 0.001 for non-fatal, P = 0.03 for fatal/non-fatal) had a higher incidence of acute coronary syndrome after kidney transplantation. All-cause mortality did not differ significantly between the groups. In a multivariate analysis, LVDD of grades 2-3 (hazard ratio 2.98, 95% confidence interval 1.535-5.787; P = 0.001), and LAE (hazard ratio 1.052, 95% confidence interval 1.006-1.101; P = 0.03) were independently associated with non-fatal acute coronary syndrome. In patients who are kidney transplant candidates, pretransplant LVDD and LAE were independently associated with a higher incidence of acute coronary syndrome after kidney transplantation.
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Affiliation(s)
- Jin Ho Hwang
- Nephrology Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Jun-Bean Park
- Cardiology Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yong-Jin Kim
- Cardiology Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Nam An
- Nephrology Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
- Department of Critical Care Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jaeseok Yang
- Transplantation Center, Seoul National University Hospital, Seoul, Korea
| | - Curie Ahn
- Transplantation Center, Seoul National University Hospital, Seoul, Korea
- Nephrology Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - In Mok Jung
- Department of Surgery, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Chun Soo Lim
- Nephrology Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Yon Su Kim
- Nephrology Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Young Hoon Kim
- Department of Surgery, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Pyo Lee
- Nephrology Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
- Nephrology Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Barberato SH, Bucharles SGE, Barberato MFA, Pecoits-Filho R. Association between Clinical and Doppler Echocardiographic Parameters with Sudden Death in Hemodialysis Patients. Arq Bras Cardiol 2016; 107:124-30. [PMID: 27411094 PMCID: PMC5074065 DOI: 10.5935/abc.20160098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 05/03/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Sudden cardiac death (SCD) is the leading cause of death in maintenance hemodialysis (HD) patients, but there is little information about underlying risk factors. OBJECTIVES Evaluate the association between clinical and echocardiographic variables with SCD on HD patients. METHODS Retrospective nested case-control study on chronic HD patients who were prospectively followed. The primary endpoint was SCD. Variables were compared by Student t test, Mann-Whitney or Chi-Square, and independent predictors of SCD were evidenced by multivariate logistic regression. RESULTS We followed 153 patients (50 ± 15 years, 58% men) for 23 ± 14 months and observed 35 deaths, 17 of which were SCD events. When compared to the control group (matched for gender, age, and body mass index) there were no differences regarding time on dialysis, traditional biochemical parameters, blood pressure, smoking, use of cardiovascular protective drugs, ejection fraction, left ventricular dimensions, and diastolic function indices. On the other hand, in the SCD group, we found a higher prevalence of previous heart failure, acute myocardial infarction and diabetes, greater left ventricular mass index, greater left atrial size and lower global myocardial performance. After multivariate logistic regression analysis, diabetes (OR = 2.6; CI = 1.3-7.5; p = 0.023) and left ventricular mass index ≥ 101 g/m2.7 (OR = 1.04; CI = 1.01-1.08; p = 0.028) showed independent association with SCD events. CONCLUSIONS HD patients with diabetes mellitus and left ventricular hypertrophy appear to have the highest risk of SCD. Preventive and therapeutic strategies should be encouraged in addressing these risk factors to minimize the occurrence of SCD in HD patients.
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Ogawa T, Koeda M, Nitta K. Left Ventricular Diastolic Dysfunction in End-Stage Kidney Disease: Pathogenesis, Diagnosis, and Treatment. Ther Apher Dial 2015; 19:427-35. [PMID: 25916171 DOI: 10.1111/1744-9987.12301] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Diastolic dysfunction is frequently observed in end-stage kidney disease (ESKD), and ESKD patients have many risk factors for heart failure (HF), including hypertension, diabetes, and coronary artery disease. Diastolic HF, also called HF with preserved ejection fraction, refers to a clinical syndrome in which patients have symptoms and signs of HF, normal or near normal left ventricular (LV) systolic function, and evidence of diastolic dysfunction manifested by abnormal LV filling and elevated filling pressure. Recent reports suggest that HF with preserved ejection fraction is more common in hemodialysis patients than HF with low ejection fraction. Diastolic HF in ESKD patients is a strong predictor of death. In this article, we review the information available in the literature on the pathogenesis, diagnosis, and potential treatment strategies of diastolic dysfunction or diastolic HF based on evidence obtained in the general population that is potentially applicable to ESKD patients.
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Affiliation(s)
- Tetsuya Ogawa
- Department of Medicine, Medical Center East and Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Misato Koeda
- Department of Medicine, Medical Center East and Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Kosaku Nitta
- Department of Medicine, Medical Center East and Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
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Westphal RJ, Bueno RRL, Galvão PBDA, Zanis Neto J, Souza JM, Guérios ÊE, Senegaglia AC, Brofman PR, Pasquini R, Cunha CLPD. Autologous transplantation of bone marrow adult stem cells for the treatment of idiopathic dilated cardiomyopathy. Arq Bras Cardiol 2015; 103:521-9. [PMID: 25590932 PMCID: PMC4290743 DOI: 10.5935/abc.20140164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 08/05/2014] [Indexed: 11/30/2022] Open
Abstract
Background Morbimortality in patients with dilated idiopathic cardiomyopathy is high, even
under optimal medical treatment. Autologous infusion of bone marrow adult stem
cells has shown promising preliminary results in these patients. Objective Determine the effectiveness of autologous transplantation of bone marrow adult
stem cells on systolic and diastolic left ventricular function, and on the degree
of mitral regurgitation in patients with dilated idiopathic cardiomyopathy in
functional classes NYHA II and III. Methods We administered 4,54 x 108 ± 0,89 x 108 bone marrow
adult stem cells into the coronary arteries of 24 patients with dilated idiopathic
cardiomyopathy in functional classes NYHA II and III. Changes in functional class,
systolic and diastolic left ventricular function and degree of mitral
regurgitation were assessed after 3 months, 6 months and 1 year. Results During follow-up, six patients (25%) improved functional class and eight (33.3%)
kept stable. Left ventricular ejection fraction improved 8.9%, 9.7% e 13.6%, after
3, 6 and 12 months (p = 0.024; 0.017 and 0.018), respectively. There were no
significant changes neither in diastolic left ventricular function nor in mitral
regurgitation degree. A combined cardiac resynchronization and implantable
cardioversion defibrillation was implanted in two patients (8.3%). Four patients
(16.6%) had sudden death and four patients died due to terminal cardiac failure.
Average survival of these eight patients was 2.6 years. Conclusion Intracoronary infusion of bone marrow adult stem cells was associated with an
improvement or stabilization of functional class and an improvement in left
ventricular ejection fraction, suggesting the efficacy of this intervention. There
were no significant changes neither in left ventricular diastolic function nor in
the degree of mitral regurgitation.
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Affiliation(s)
| | | | | | - José Zanis Neto
- Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | | | | | | | - Paulo Roberto Brofman
- Centro de Pesquisa, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
| | - Ricardo Pasquini
- Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
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Franczyk-Skóra B, Gluba A, Olszewski R, Banach M, Rysz J. Heart function disturbances in chronic kidney disease - echocardiographic indices. Arch Med Sci 2014; 10:1109-16. [PMID: 25624846 PMCID: PMC4296068 DOI: 10.5114/aoms.2014.47822] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 11/25/2014] [Accepted: 12/01/2014] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION In chronic kidney disease (CKD) patients left ventricular (LV) diastolic dysfunction occurs frequently and is associated with heart failure (HF) and higher mortality. Left ventricular systolic dysfunction is associated with coronary artery disease (CAD) and is a major determinant of prognosis. The aim of this study was to assess indices of LV diastolic dysfunction in CKD patients. MATERIAL AND METHODS Study included 118 CKD patients. All patients underwent transthoracic echocardiography. Diastolic function based on E and A, E/A ratio and pulmonary vein flow velocities as well as EF%, deceleration time, RA, LA volume were assessed. In dialysis patients examination was carried out before and after dialysis. RESULTS In CKD patients the stage of renal failure was associated with the significant increase in LV mass (268.0 ±47.6 CKD I/II vs. 432.7 ±122.4 CKD V/dialysis, p < 0.0001), systolic LV (37.3 ±4.5 vs. 51.2 ±8.9, p < 0.0001) and diastolic LV (CKD I-II 44.7 ±4.1 vs. CKD III 48.5 ±6.7 vs. CKD IV 47.1 ±5.6; p = 0.004) dimensions and in the size of the LA (40.4 ±2.0 vs. 41.9 ±2.7 vs. 42.3 ±3.2 vs. 44.8 ±3.1; p < 0.0001). The increase the E/E' ratio between groups of patients (6.7 ±1.5 vs. 8.9 ±2.4 vs. 11.5 ±4.0 vs. 13.5 ±5.0; p < 0.0001) was seen in this study. The reduction in deceleration time (247.2 ±34.5 in CKD I/II vs. 197.4 ±61.0 in CKD IV, p = 0.0005) along with the decrease in estimated glomerular filtration rate was also observed in this study. CONCLUSIONS Early identification of factors involved is necessary to prevent this devastating process. Many indexes of contractility are used and each of them has imperfections. It seems that TVI, E, E/A and E/E' are good instruments for the early detection of left ventricular hypertrophy and diastolic dysfunction.
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Affiliation(s)
- Beata Franczyk-Skóra
- Department of Nephrology, Hypertension and Family Medicine, WAM University Hospital of Lodz, Lodz, Poland
| | - Anna Gluba
- Department of Nephrology, Hypertension and Family Medicine, WAM University Hospital of Lodz, Lodz, Poland
- Healthy Aging Research Center, Medical University of Lodz, Lodz, Poland
| | - Robert Olszewski
- Department of Cardiology and Internal Medicine, Military Medical Institute of Warsaw, Warsaw, Poland
| | - Maciej Banach
- Healthy Aging Research Center, Medical University of Lodz, Lodz, Poland
- Department of Hypertension, Medical University of Lodz, Lodz, Poland
| | - Jacek Rysz
- Department of Nephrology, Hypertension and Family Medicine, WAM University Hospital of Lodz, Lodz, Poland
- Healthy Aging Research Center, Medical University of Lodz, Lodz, Poland
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Dalsgaard M, Egstrup K, Wachtell K, Cramariuc D, Kjaergaard J, Gerdts E, Hassager C. Left atrial volume as predictor of valve replacement and cardiovascular events in patients with asymptomatic mild to moderate aortic stenosis. Echocardiography 2013; 30:1008-14. [PMID: 23551697 DOI: 10.1111/echo.12184] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Left atrial (LA) size is known to increase with chronically increased left ventricular (LV) filling pressure. We hypothesized that LA volume was predictive of aortic valve replacement (AVR) and cardiovascular events in a large cohort of patients with asymptomatic mild to moderate aortic valve stenosis. METHODS Transthoracic echocardiography was performed in 1,758 patients in the Simvastatin and Ezetemibe in Aortic Stenosis study. LA volume was measured in the apical four-chamber view in 1,503 patients (85%). The relation of LA volume to AVR or a combined endpoint of cardiovascular events (AVR, congestive heart failure due to aortic stenosis or death from cardiovascular causes) was evaluated. RESULTS AVR was performed in 415 (28%) patients, whereas 505 (34%) reached the combined endpoint. A significant but weak association of increased LA volume and risk of the combined endpoint was found (log-rank test: P = 0.02), but this relation did not reach any significance in a multivariate model adjusting for age, gender, aortic valve area index, LV ejection fraction, LV hypertrophy, hypertension, and mitral regurgitation. LA volume was not predictive of AVR (log-rank test: P = 0.3). CONCLUSION In asymptomatic patients with mild to moderate Aortic valve stenosis (AS), LA volume was not predictive of the combined endpoint of Aortic valve replacement, development of heart failure or cardiac death. AVA and presence of LV hypertrophy were the only predictors of events in multivariate analysis.
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Affiliation(s)
- Morten Dalsgaard
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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12
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Park CS, Kim YK, Song HC, Choi EJ, Ihm SH, Kim HY, Youn HJ, Seung KB. Effect of preload on left atrial function: evaluated by tissue Doppler and strain imaging. Eur Heart J Cardiovasc Imaging 2012; 13:938-47. [PMID: 22514009 DOI: 10.1093/ehjci/jes069] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Both strain and strain rate (SR) measure the regional myocardial deformation and can assess phasic left atrial (LA) function. However, there is still a lack of evidence for their volume independency. In this study, strain and SR determined by tissue Doppler imaging were used to evaluate the effect of preload reduction in end-stage renal disease patients who were undergoing regular haemodialysis (HD). METHODS AND RESULTS Forty-one subjects who underwent transthoracic echocardiography just before and after HD were enrolled. LA strain was measured during late systole, and LA peak tissue velocity and SR were measured during systole and during early and late diastolic periods. The values of tissue velocity, strain, and SR were obtained in the basal septal, lateral, inferior, and anterior walls of the LA. The mean strain value was 23.89 ± 7.29% at baseline and decreased to 21.88 ± 5.85% after HD (P = 0.019). SR during systole (before HD 1.55 ± 0.40; after HD 1.38 ± 0.35, P = 0.001) and early diastole (before HD -1.41 ± 0.54; after HD -1.16 ± 0.45, P = 0.001) also changed. However, the acute preload change caused by HD did not affect the peak tissue velocity (before HD -6.34 ± 1.58 cm/s; after HD -6.46 ± 1.54 cm/s, P = 0.436) and the SR (before HD -1.36 ± 0.45/s; after HD -1.34 ± 0.29/s, P = 0.621) measured during late diastole. CONCLUSION Both tissue velocity and SR during late diastole, representing the contractile function of the LA, are relatively preload-independent parameters and are available for the evaluation of the LA function.
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Affiliation(s)
- Chan Seok Park
- Division of Cardiology and Nephrology, College of Medicine, Catholic University of Korea, 505 Banpo-dong, Seocho-gu, Seoul 137-701, Republic of Korea
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Hsiao SH, Lin KL, Chiou KR. Comparison of left atrial volume parameters in detecting left ventricular diastolic dysfunction versus tissue Doppler recordings. Am J Cardiol 2012; 109:748-55. [PMID: 22152972 DOI: 10.1016/j.amjcard.2011.10.040] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 10/25/2011] [Accepted: 10/25/2011] [Indexed: 10/14/2022]
Abstract
Because of diastolic coupling between the left atrium and left ventricle, we hypothesized that left atrial (LA) function mirrors the diastolic function of left ventricle. The aims of this study were to assess whether LA volume parameters can be good indexes of left ventricular diastolic dysfunction. Six hundred fifty-nine patients underwent cardiac catheterization and measurements of left ventricular filling pressure (LVFP). Echocardiographic examinations including tissue Doppler and LA volumes were also assessed. Ratio of early diastolic mitral inflow velocity to early diastolic mitral annular velocity and LVFP tended to increase after progression of diastolic dysfunction. The inverse phenomenon existed in LA ejection and LA distensibility. LA distensibility was superior to LA ejection fraction and early diastolic mitral inflow velocity/early diastolic mitral annular velocity for identifying LVFP >15 mm Hg (areas under receiver operating characteristic curve 0.868, 0.834, and 0.759, respectively) and for differentiating pseudonormal from normal diastolic filling (areas under receiver operating characteristic curve 0.962, 0.907, and 0.741, respectively). Multivariate logistic regression showed that LA ejection fraction and LA distensibility were associated significantly with the presence of pseudonormal/restrictive ventricular filling. In conclusion, LA volume parameters can identify LVFP >15 mm Hg and differentiate among patterns of ventricular diastolic dysfunction. For assessing diastolic function LA parameters offer better performance than even tissue Doppler.
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14
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Left atrial dilatation and ST-T changes predict cardiovascular outcome in chronic hemodialysis patients. Heart Vessels 2011; 27:610-7. [DOI: 10.1007/s00380-011-0189-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Accepted: 08/26/2011] [Indexed: 10/17/2022]
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Ramasubbu K, Deswal A, Herdejurgen C, Aguilar D, Frost AE. A prospective echocardiographic evaluation of pulmonary hypertension in chronic hemodialysis patients in the United States: prevalence and clinical significance. Int J Gen Med 2010; 3:279-86. [PMID: 21042428 PMCID: PMC2962323 DOI: 10.2147/ijgm.s12946] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Pulmonary hypertension (PH), a disease which carries substantial morbidity and mortality, has been reported to occur in 25%-45% of dialysis patients. No prospective evaluation of the prevalence or clinical significance of PH in chronic dialysis patients in the United States (US) has been undertaken. METHODS Echocardiograms were performed prospectively in chronic hemodialysis patients prior to dialysis at a single dialysis center. PH was defined as a tricuspid regurgitant jet ≥2.5 m/s and "more severe PH" as ≥3.0 m/s. Clinical outcomes recovered were all-cause hospitalizations and death at 12 months. RESULTS In a cohort of 90 patients, 42 patients (47%) met the definition of PH. Of those, 18 patients (20%) met the definition of more severe PH. At 12 months, mortality was significantly higher in patients with PH (26%) compared with patients without PH (6%). All-cause hospitalizations were similar in patients with PH and without PH. Echocardiographic findings suggesting impaired left ventricular function and elevated pulmonary capillary wedge pressure were significantly associated with PH. CONCLUSION This prospective cross-sectional study of a single dialysis unit suggests that PH may be present in nearly half of US dialysis patients and when present is associated with increased mortality. Echocardiographic findings demonstrate an association between elevated filling pressures, elevated pulmonary artery pressures, and higher mortality, suggesting that the PH may be secondary to diastolic dysfunction and compounded by volume overload.
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Affiliation(s)
- Kumudha Ramasubbu
- Section of Cardiology, Michael E DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, USA
| | - Anita Deswal
- Section of Cardiology, Michael E DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, USA
| | - Cheryl Herdejurgen
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - David Aguilar
- Section of Cardiology, Michael E DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, USA
| | - Adaani E Frost
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, Texas, USA
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Cai Q, Serrano R, Kalyanasundaram A, Shirani J. A preoperative echocardiographic predictive model for assessment of cardiovascular outcome after renal transplantation. J Am Soc Echocardiogr 2010; 23:560-6. [PMID: 20381999 DOI: 10.1016/j.echo.2010.03.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Major adverse cardiac events (MACE) frequently determine the outcome of renal transplantation (RT). Stress testing is advocated for preoperative risk assessment, but limited information is available on the prognostic value of these tests. We aimed to retrospectively assess the value of preoperative dobutamine stress echocardiography (DSE) in predicting MACE in patients undergoing RT. METHODS A total of 185 patients (age 56 +/- 11 years, 64% were men, creatinine level of 7.3 +/- 2.9 mg/d, 27% were smokers, 86% had hypertension, 54% had diabetes, 57% were dyslipidemic) with end-stage renal disease (ESRD) underwent DSE before RT. A standard DSE protocol was used with the administration of 5-50 mug/kg/min incremental doses in 3-minute intervals and up to 1 mg of atropine if needed to reach prespecified end points. RESULTS Regional left ventricular wall motion abnormality (WMA) at rest (fixed), with stress (inducible), or both were present in 54, 35, and 18 patients, respectively. In 38 patients who underwent coronary angiography, the sensitivity, specificity, and positive and negative predictive values of inducible WMA for predicting angiographic coronary artery disease (> or = 70% luminal diameter reduction) were 88%, 62%, 65%, and 87%, respectively. Cox regression analysis identified the presence of combined fixed and inducible WMA (ie, resting WMA that did not change during DSE, accompanied by new WMA evident during DSE; hazard ratio [HR] 5.6, P = .012), left atrial enlargement (HR 4.2, P = .002), and aortic valve sclerosis (HR 3.9, P = .013) as independent predictors of 48-month MACE (cardiac death, nonfatal acute myocardial infarction, and coronary revascularization after RT). Patients with all 3 predictors had a 48-month MACE of 60% compared with 5% in those with none (P = .007). Compared with those without WMA, patients with both fixed and inducible WMA had a higher rate of MACE at 48 months (7% vs 33%, P = .004). CONCLUSION In RT candidates, DSE can effectively identify those at low and high risk of MACE.
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Affiliation(s)
- Qiangjun Cai
- Department of Internal Medicine, Geisinger Medical Center, Danville, Pennsylvania 17822, USA
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Affiliation(s)
- Queenie Lo
- Liverpool HospitalDepartment of CardiologySydneyNew South Wales2170Australia
| | - Liza Thomas
- Liverpool HospitalDepartment of CardiologySydneyNew South Wales2170Australia
- The University of New South WalesSydneyNew South Wales2052Australia
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Abstract
Patients with chronic kidney disease are well recognized to develop a wide range of cardiac structural and functional abnormalities. These changes may be progressive and relate directly to a grossly aggravated risk of cardiovascular events and reduced survival. Although conventional methods of cardiac assessment have been shown to be useful, they are limited by insufficient sensitivity and specificity, to fully appreciate the overall degree of myocardial distress that is common in these patients. This article aims to review the use of established and emerging cardiac imaging tools and, in particular, their application in patients with chronic kidney disease.
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Echocardiographic assessment of left ventricular diastolic function: what we able to do in 2009. COR ET VASA 2009. [DOI: 10.33678/cor.2009.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Barberato SH, Misocami M, Pecoits-Filho R. Association between Left Atrium Enlargement and Intradialytic Hypotension: Role of Diastolic Dysfunction in the Hemodynamic Complications during Hemodialysis. Echocardiography 2009; 26:767-71. [DOI: 10.1111/j.1540-8175.2008.00885.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Zielinsky P, Luchese S, Manica JL, Piccoli AL, Nicoloso LH, Leite MF, Hagemann L, Busato A, Moraes MR. Left atrial shortening fraction in fetuses with and without myocardial hypertrophy in diabetic pregnancies. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 33:182-187. [PMID: 19012275 DOI: 10.1002/uog.6154] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To test the hypothesis that, in diabetic pregnancies, left atrial shortening fraction (LASF) is decreased in fetuses with myocardial hypertrophy, compared to those without hypertrophy and to fetuses of non-diabetic mothers. METHODS Fetal echocardiography was performed in women with pre-existing or gestational diabetes and in non-diabetic controls between 25 weeks' gestation and term. LASF was calculated using the formula: (end-systolic diameter-end-diastolic diameter)/end-systolic diameter, and data were compared between diabetic women with and without fetal myocardial hypertrophy and controls. RESULTS The study population comprised 53 diabetic women and 45 controls. Out of the 53 fetuses of diabetic women, 14 had myocardial hypertrophy and 39 had normal septal thickness. Gestational age at the time of examination did not differ significantly between the control group and the two diabetic subgroups (P = 0.57). Fetuses with myocardial hypertrophy presented a mean ( +/- SD) LASF of 0.32 +/- 0.11, those without myocardial hypertrophy 0.46 +/- 0.12, and those of normal mothers 0.53 +/- 0.09 (P < 0.001). A significant inverse linear correlation was observed between LASF and septal thickness (r = - 0.51, P < 0.001). CONCLUSIONS In diabetic pregnancies, LASF is lower in fetuses with myocardial hypertrophy than it is in those without hypertrophy and in fetuses of non-diabetic women, suggesting that LASF could be a useful alternative parameter in the assessment of fetal diastolic function.
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Affiliation(s)
- P Zielinsky
- Fetal Cardiology Unit, Institute of Cardiology of Rio Grande do Sul/Porto Alegre, Brazil.
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Leung DY, Boyd A, Ng AA, Chi C, Thomas L. Echocardiographic evaluation of left atrial size and function: current understanding, pathophysiologic correlates, and prognostic implications. Am Heart J 2008; 156:1056-64. [PMID: 19032999 DOI: 10.1016/j.ahj.2008.07.021] [Citation(s) in RCA: 214] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2008] [Accepted: 07/23/2008] [Indexed: 01/07/2023]
Abstract
Left atrial (LA) volume has recently been identified as a potential biomarker for cardiac and cerebrovascular disease. However, evidence regarding the prognostic implications of LA volume still remains unclear. Evaluation of LA size and function using traditional and more recent echocardiographic parameters is potentially feasible in the routine clinical setting. This review article discusses the conventional and newer echocardiographic parameters used to evaluate LA size and function. Conventional parameters include the assessment of phasic atrial activity using atrial volume measurements, transmitral Doppler peak A velocity, atrial fraction, and the atrial ejection force. Newer parameters include Doppler tissue imaging (DTI) including segmental atrial function assessment using color DTI, strain, and strain rate. In addition, an overview of the implications and clinical relevance of the findings of an enlarged left atrium, from currently available literature, is presented.
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Zoccali C, Mallamaci F, Benedetto FA, Tripepi G, Pizzini P, Cutrupi S, Malatino L. Urotensin II and Cardiomyopathy in End-Stage Renal Disease. Hypertension 2008; 51:326-33. [DOI: 10.1161/hypertensionaha.107.101188] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Carmine Zoccali
- From the Consiglio Nationale delle Ricerche (CNR)-Istituto di Biomedicina (IBIM) (C.Z., F.M., F.A.B., G.T., P.P., S.C.), Institute of Biomedicine, Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension and Division of Nephrology, Dialysis and Transplantation, Reggio Calabria, Italy; and the Department of Medicine (L.M.), University of Catania, Catania, Italy
| | - Francesca Mallamaci
- From the Consiglio Nationale delle Ricerche (CNR)-Istituto di Biomedicina (IBIM) (C.Z., F.M., F.A.B., G.T., P.P., S.C.), Institute of Biomedicine, Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension and Division of Nephrology, Dialysis and Transplantation, Reggio Calabria, Italy; and the Department of Medicine (L.M.), University of Catania, Catania, Italy
| | - Frank Antonio Benedetto
- From the Consiglio Nationale delle Ricerche (CNR)-Istituto di Biomedicina (IBIM) (C.Z., F.M., F.A.B., G.T., P.P., S.C.), Institute of Biomedicine, Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension and Division of Nephrology, Dialysis and Transplantation, Reggio Calabria, Italy; and the Department of Medicine (L.M.), University of Catania, Catania, Italy
| | - Giovanni Tripepi
- From the Consiglio Nationale delle Ricerche (CNR)-Istituto di Biomedicina (IBIM) (C.Z., F.M., F.A.B., G.T., P.P., S.C.), Institute of Biomedicine, Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension and Division of Nephrology, Dialysis and Transplantation, Reggio Calabria, Italy; and the Department of Medicine (L.M.), University of Catania, Catania, Italy
| | - Patrizia Pizzini
- From the Consiglio Nationale delle Ricerche (CNR)-Istituto di Biomedicina (IBIM) (C.Z., F.M., F.A.B., G.T., P.P., S.C.), Institute of Biomedicine, Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension and Division of Nephrology, Dialysis and Transplantation, Reggio Calabria, Italy; and the Department of Medicine (L.M.), University of Catania, Catania, Italy
| | - Sebastiano Cutrupi
- From the Consiglio Nationale delle Ricerche (CNR)-Istituto di Biomedicina (IBIM) (C.Z., F.M., F.A.B., G.T., P.P., S.C.), Institute of Biomedicine, Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension and Division of Nephrology, Dialysis and Transplantation, Reggio Calabria, Italy; and the Department of Medicine (L.M.), University of Catania, Catania, Italy
| | - Lorenzo Malatino
- From the Consiglio Nationale delle Ricerche (CNR)-Istituto di Biomedicina (IBIM) (C.Z., F.M., F.A.B., G.T., P.P., S.C.), Institute of Biomedicine, Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension and Division of Nephrology, Dialysis and Transplantation, Reggio Calabria, Italy; and the Department of Medicine (L.M.), University of Catania, Catania, Italy
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