Purpose: Right ventricular (RV) dysfunction is known as a major cause of death in patients with maintenance hemodialysis (MHD). We used conventional and real-time three-dimensional echocardiography (RT-3DE) to evaluate the long-and short-term impact of MHD on RV function.
Methods: Echocardiography was performed on 110 consecutively enrolled individuals, including 30 controls and 80 patients with MHD. Conventional echocardiographic parameters and RT-3DE parameters were obtained. Right ventricular volumes and systolic parameters were analyzed and compared between the two groups to reveal the long-term impact of hemodialysis on RV. Among them, fourteen patients with intradialytic hypotension (IDH) and 14 patients without IDH (non-IDH) were analyzed before and shortly after one hemodialysis session, in order to detect the short-term impact of hemodialysis on RV.
Results: RV end-diastolic volume (EDV-rv) were markedly enlarged (47.1±11.8ml/m2 VS 42.3±8.6 ml/m2, p=0.056), while RV ejection fraction (RVEF) was significantly lower in the MHD patients than the control group (50.6±5.8% VS 55.2±3.7%, p<0.001). The RV global, septal and lateral longitudinal strains (LS-rv, LS-sep, LS-lat) were also decreased in MHD group (LS-rv: -18.2±3.6 VS -22.6±4.3%; LS-sep: -13.1±3.8 VS -17.5±5.5%; LS-lat: -23.4±4.7 VS -27.7±4.0%, all p<0.001). History of coronary heart disease was an independent factor for predicting RVEF reduction. RV diastolic function was impaired in MHD Group, demonstrated by lower tricuspid E/A and E'/A' ratios. For the short-term effects, RVEF and RV longitudinal strains were increased after the HD session in the non-IDH group (RVEF: from 52.0±4.3% to 53.1±4.3%, p=0.067; LS-sep: from -12.7±1.7% to -14.8±2.2%, p=0.001; LS-rv: from -18.2±2.4% to -19.4±1.7%, p=0.033), while RVEF and RV longitudinal strains were decreased in the IDH group (RVEF: from 45.9±2.6% to 43.7±3.4%; LS-sep: from -11.7±2.1% to -10.1±2.1%; LS-lat: from -21.8±4.0% to-18.2±3.8%; LS-rv: from -16.7±2.5% to -14.1±2.1%, all p<0.01). However, RV diastolic function remained unchanged after HD in the two groups.
Conclusions: MHD patients endure the deterioration of right ventricular function. However, one session of HD may have different effects on non-IDH and IDH groups. RT-3DE has potential in the RV evaluation and risk stratification in MHD patients.