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Long- and short-term impacts of hemodialysis on right ventricle: assessment via real-time three-dimensional echocardiography

Session Poster session 2

Speaker Minmin Sun

Congress : ESC Congress 2017

  • Topic : imaging
  • Sub-topic : Echocardiography: Systolic and Diastolic Function
  • Session type : Poster Session
  • FP Number : P1436

Authors : MM Sun (Shanghai,CN), XH Shu (Shanghai,CN), XS Cao (Shanghai,CN), Y Guo (Shanghai,CN), X Tan (Shanghai,CN), LL Dong (Shanghai,CN), CZ Pan (Shanghai,CN), JB Ge (Shanghai,CN)

M.M. Sun1 , X.H. Shu1 , X.S. Cao1 , Y. Guo1 , X. Tan1 , L.L. Dong1 , C.Z. Pan1 , J.B. Ge1 , 1Zhongshan Hospital of Fudan University - Shanghai - China People's Republic of ,

European Heart Journal ( 2017 ) 38 ( Supplement ), 290

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.

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