Changes in left ventricular size, wall thickness, and function in anemic patients treated with recombinant human erythropoietin

Abstract

Left ventricular size and function were evaluated in 15 anemic chronic hemodialysis patients before and after the administration of recombinant human erythropoietin (rHuEPO). All patients were studied with two-dimensional and M-mode echocardiographic examinations before the initiation of rHuEPO (T1) and at 28 ± 7 weeks of rHuEPO therapy (T2). The two-dimensional targeted M-mode echocardiographic measurements obtained were: end-diastolic dimension (EDD); end-systolic dimension (ESD); stroke dimension (SD); dimensional shortening ( SD EDD ); systolic posterior wall thickness (PWs); diastolic posterior and interventricular septal thickness; end-systolic wall stress (ESWS); and left ventricular mass. Mean hematocrit in these patients increased almost 50%. The EDD decreased from a mean value (±SEM) of 6.41 ± 0.33 to 4.93 ± 0.21 cm ( p < 0.05). ESD decreased from a mean value of 4.16 ± 1.2 to 2.77 ± 0.06 cm ( p < 0.05). The calculated mean SD decreased slightly but not significantly from 2.21 ± 0.69 to 2.19 ± 0.60 cm. The calculated SD EDD increased from a mean 0.35 ± 0.09 to 0.44 ± 0.07 ( p < 0.05). ESWS fell from 59.2 ± 12.2 to 37.6 ± 9.3 gm/cm 2 ( p < 0.01), and left ventricular mass fell ( p < 0.05) from 347 ± 15.2 to 227 ± 59 gm. There was no significant difference in resting heart rate or systolic blood pressure between T1 and T2. The increase in dimension shortening reflects afterload reduction, as indicated by the fall in end-systolic wall stress. A primary improvement in myocardial contractile function as a consequence of an rHuEPO-mediated increase in red blood cell mass, may also play a role.