Hemodialysis improves myocardial interstitial edema and left ventricular diastolic function in patients with end-stage renal disease: noninvasive assessment by ultrasonic tissue characterization.

Abstract

Congestive heart failure is the most common cause of mortality in patients with end-stage renal disease (ESRD). Ultrasonic tissue characterization with integrated backscatter offers a promising method for the noninvasive assessment of regional myocardial contractile performance and fibrosis. The aim of this study was to investigate the effect of hemodialysis (HD) on myocardial tissue characterization and left ventricular function in ESRD patients. We examined 26 patients with ESRD undergoing routine HD (age 63 +/- 12 years, duration of HD 9.2 +/- 3.2 years) and 30 patients with essential hypertension (HT; 60 +/- 10 years). Routine echocardiographic parameters and the cyclic variation of ultrasonic integrated backscatter of the ventricular septum (CV-IBS) were measured. Left ventricular mass index was significantly larger in patients with ESRD than in those with HT (217 +/- 56 vs 146 +/- 45 g/m(2), P < 0.05). The indices for left ventricular diastolic function (E/A, the ratio of left ventricular peak early to late diastolic filling velocity; DT, the deceleration time of the early diastolic filling) and CV-IBS had deteriorated significantly in patients with ESRD before HD compared with those with HT (E/A, 0.6 +/- 0.2 vs 0.9 +/- 0.3, P < 0.05; DT, 228 +/- 23 vs 184 +/- 19 ms, P < 0.05; CV-IBS, 9.0 +/- 1.3 vs 12.4 +/- 0.9 dB, P < 0.05), possibly reflecting interstitial fibrosis. In patients with ESRD, HD reduced calculated left ventricular mass index by 19% (before HD, 217 +/- 56 vs immediately after HD, 176 +/- 45 g/m(2), P < 0.05) and CV-IBS by 19% (9.0 +/- 1.3 vs 7.3 +/- 1.1 dB, P < 0.05), that possibly reflected improvement of interstitial edema. HD also significantly improved indices for left ventricular diastolic function (E/A, 0.6 +/- 0.2 vs 0.9 +/- 0.2, P < 0.05; DT, 228 +/- 23 vs 188 +/- 21 ms, P < 0.05). HD improves myocardial interstitial edema and left ventricular diastolic function in patients with ESRD. Noninvasive assessment of ultrasonic tissue characterization is useful in defining the pathophysiological changes of ventricular myocardium in patients with ESRD.