Withdrawal

Abstract

Some acute changes occur in the myocardium during a hemodialysis (HD) session and for understanding the causes and importance of these changes we need to conduct studies which may clarify the contradictory results published up to date. This study is aimed to evaluate the acute effects of HD on the myocardium using 3 dimensional speckle tracking echocardiography (3DSTE) in patients with and without hypotension during a dialysis session. We examined our HD patients who had normal ejection fraction (n=45) just before and after a HD session using 3DSTE. We recorded their demographic data, comorbidity status, renal replacement therapy characteristics and laboratory test results accordingly. Patients (n=12) with a history of intradialytic hypotension (IDH) occurring at least 30 % of their last 10 HD sessions formed the IDH group. The LV global longitudinal, circumferential area and radial peak systolic strain as well as RV Septum and Freewall longitudinal strain and fractional area change were calculated with 3DSTE analyses. After excluding 6 patients the data of the remaining 39 patients (18 males, 46.1 %, with mean age of 56.8 years) was analyzed. In the non-IDH group decreases observed in Septum LS, Freewall LS and FAC following HD sessions was found insignificant (p=0.57; p=0.12; p=0.16, respectively). In the IDH group RV volume indexes and EF decreased significantly (p= 0.001; p=0.01, respectively) and Septum LS, Freewall LS and FAC worsened significantly (p=0.04; p=0.05; p=0.03, respectively) following HD sessions. A significant stunning effect was observed in the RV. Except twist and torsion all LV strain parameters were changed in both groups. In the IDH group changes observed in the GLS, GCS, GRS and area strain were larger compared to the non-IDH group. There was significant worsening in LV strain measurements following HD sessions in both groups. HD treatment results in deterioration in all LV strain directions in both groups. RV strain parameters worsened statistically significant only in the IDH group. In patients with IDH the stunning effect of the session on both ventricles contributes to the long term effects of HD on the myocardium. Adjusting the ultrafiltration rate low in patients with IDH is also protective in RV strain deterioration and may break the vicious cycle preventing IDH patients to tolerate HD.