Abstract 19086: Pulmonary Hypertension Accompanied by Changes in Left Ventricular Structure and Function in End Stage Renal Disease Patients on Maintenance Hemodialysis

Abstract

Introduction: Pulmonary hypertension (PH) is increasingly recognized in patients with end stage renal disease (ESRD) on hemodialysis (HD). The causes of PH include features characteristic of ESRD and HD including the hemodynamic effects of an AV fistula and left heart disease. Although LV abnormalities occur frequently in ESRD patients, the association of such abnormalities with PH has been rarely studied. Hypothesis: PH in patients on chronic HD is associated with LV structural and functional abnormalities, including LV diastolic dysfunction (LVDF). Methods: Ninety- four patients (age range, 23-77 years; females, 45) underwent Doppler echocardiography 10-12 hours after HD. PH was considered present when the pulmonary artery systolic pressure (PAP) was ≥ 40 mmHg. LV measurements included thickness of the interventricular septum (IVS) and posterior wall (PW); LV mass; LV size calculated from the LV internal dimensions at the end of diastole and systole (LVIDd and LVIDs); and LV systolic function from ejection fraction (EF). LVDF was assessed from mitral diastolic velocity waves: deceleration time (DT) of the early wave (E) and the ratio (E/A) of E and the late velocity (A). Results: Sixty- seven patients (71%) had PH whereas 27 patients (29%) had normal PAP (<40 mmHg). Systolic and diastolic blood pressures (155 ± 29 vs. 148 ± 25 mm Hg, p =0.3; and 82 ± 15 vs. 84 ± 13 mm Hg, p = 0.38) were similar in patients with PH and those with a normal PAP (NPAP). LVIDd (5.21 ± 0.88 vs. 4.87 ± 0.84 cm, p= 0.05); LVIDs (3.45 ± 0.96 vs. 3.07± 0.76 cm, p= 0.05); IVS and PW thicknesses (1.03 ± 0.15 vs. 1.09 ± 0.19 cm, p = 0.19; and 1.07 ± 0.16 vs. 1.12 ± 0.17 cm, p = 0.25); and LV mass, (123 ± 38 vs. 113 ± 3 g/m 2 , p= 0.12) were all similar in PH vs. NPAP patients. The LVEF was lower in PH than in NPAP patients (46.4 ± 17.6 vs. 62.4 ± 14.4%, p < 0.001). Both groups exhibited DTs of > 200 ms (215 ± 47 vs. 257 ± 52 ms, p = 0.006), with no significant between-group difference in the E/A ratio (E/A 1.48 ±0.74 vs. 1.15 ±0.44, p=0.06). Conclusions: We observed a surprisingly high prevalence of PH among patients on HD. PH was associated with a moderate depression in LV systolic function in the absence of clear changes in LVDF. Further studies are warranted to clarify the role of LVDF in the pathogenesis of PH in HD patients.