Abstract 3357: Haemodialysis Induced Contractile Dysfunction is Associated with Acute and Reversible Reduction in Global and Segmental Myocardial Blood Flow

Abstract

Hemodialysis (HD) is associated with acute cardiac ischemia, as evidenced by the development of regional wall motion abnormalities (RWMAs). Repetitive acute myocardial ischemia may lead to the development of chronic left ventricular (LV) dysfunction. This study utilised serial H 2 15 O PET scans to confirm that the development of HD-induced RWMAs was associated with reduction in myocardial blood flow (MBF). Four prevalent HD patients without angiographically significant coronary artery disease (CAD) had measurements of MBF during standard HD and biofeedback dialysis (BFD). All patients underwent serial measurements of MBF using PET. Echocardiography was used concurrently to assess LV function. Hemodynamic variables were measured using continuous pulse wave analysis. Mean pre-HD MBF was within the normal range. Global MBF was acutely reduced during HD (see figure ) (P<0.002). Segmental MBF was significantly reduced in areas that developed RWMAs compared to those that did not (P<0.001). Not all regions with reduced MBF were functionally affected but a reduction in MBF of >30% from baseline was associated with the development of RWMAs (P<0.01). No significant differences in haemodynamic tolerability, RWMA development or MBF between dialysis modality were observed. HD is associated with repetitive myocardial ischemia which in absence of significant CAD may be due to coronary microvascular dysfunction. Stress induced, segmental LV dysfunction correlates with a matched reduction in MBF. Functional post-stress recovery is consistent with myocardial stunning induced by HD. This process may be an important component in the development of heart failure in chronic HD patients.