Ventricular Function in Patients with End‐Stage Renal Disease Starting Dialysis Therapy: A Tissue Doppler Imaging Study

Abstract

Heart failure is prevalent in end-stage renal disease (ESRD) patients on long-term dialysis. Detection of right ventricular (RV) dysfunction before starting dialysis may help to identify patients at a higher risk of developing heart failure. To assess RV function in predialysis patients using tissue Doppler imaging (TDI) derived myocardial performance index of RV (MPI-RV). Echocardiography including pulsed TDI of lateral tricuspid annulus was performed in 41 patients with ESRD before starting dialysis therapy and 12 age and gender matched healthy controls. RV dysfunction was defined as MPI > 0.4; a value above the median MPI in controls. Compared to controls, ESRD patients had significantly higher blood pressure and lower hemoglobin level. MPI-RV was significantly impaired in ESRD patients compared to control (0.6 vs. 0.4, P < 0.001). RV dysfunction was identified in 23 ESRD patients (56%). ESRD patients had significantly lower e' velocity and e'/a' ratio as compared with controls. Pulmonary hypertension was detected in 15 (36.5%) patients. Among ESRD patients, no correlation was detected between MPI-RV and calculated mean pulmonary artery pressure (r = -0.13, P = 0.47), pulmonary artery systolic pressure (r =-0.12, P = 0.6), left ventricular ejection fraction (r = 0.294, P = 0.06), or MPI of left ventricle (r = 0.3, P = 0.065). ESRD patients with and without pulmonary hypertension had similar MPI-RV (0.6 vs.0.62, P = 0.32). Subclinical RV dysfunction-as estimated by TDI derived MPI-is highly prevalent among ESRD patients even before starting dialysis therapy. Pulmonary hypertension is not significantly associated with RV dysfunction in these patients.