Assessment of left ventricular function in patients with chronic renal failure undergoing hemodialysis

Abstract

Objectives The objective is speckle tracking echocardiography evaluation of left ventricular (LV) function in hemodialysis patients versus uremic nondialysis patients. Background Hemodialysis patients have a high cardiovascular risk and mortality even with normal LV function by conventional echocardiography. Settings and design A total of 75 patients with LV ejection fraction more than 50% were enrolled prospectively and assigned into two groups. Patients and methods Group 1 included 45 patients with chronic renal failure on regular hemodialysis three times/week for more than 2 years, and group 2 included 30 nondialysis patients with chronic kidney disease in the early stages. Statistical analysis used This was a comparative case-control study. Results Global peak systolic longitudinal strain was significantly lower in hemodialysis patients than nondialysis (−15.09 ΁ 3.36 vs. −17.96 ΁ 2.24, P = 0.0001). Moreover, average regional peak systolic longitudinal strain of 4CH, 2CH, 3CH, basal, mid, and apical regions was significantly lower in hemodialysis group than nondialysis (−14.77 ΁ 3.48 vs. −17.52 ΁ 2.42, respectively, P = 0.0003; −15.02 ΁ 3.99 vs. −18.08 ΁ 3.60, respectively, P = 0.001; −15.46 ΁ 4.28 vs. −18.28 ΁ 3.06, respectively, P = 0.003; −11.83 ΁ 3.2 vs. −15.23 ΁ 2.94, respectively, P < 0.0001; −14.62 ΁ 3.31 vs. −17.72 ΁ 2.36, respectively, P < 0.0001; and −18.79 ΁ 5.08 vs. −20.3 ΁ 3.64, respectively, P = 0.049). Global systolic strain rate and early diastolic strain rate (1/s) in dialysis patients were significantly delayed than nondialysis (−0.92 ΁ 0.20 vs. −1.07 ΁ 0.13, respectively, P = 0.001, and 0.90 ΁ 0.26 vs. 1.0 ΁ 0.18, respectively, P = 0.003), and global systolic strain rates less than −1 in hemodialysis patients was 62.22 versus 26.67% in group 2, P = 0.003. Conclusion Hemodialysis patients have more affection and reduction of LV functions including global, regional longitudinal strain, systolic strain rate, and early diastolic strain rate. Impaired LV systolic and diastolic functions could be detected and accurately assessed by two-dimensional speckle tracking echocardiography despite being normal by conventional echocardiography.