Two-dimensional Echocardiographic Studies Research Articles

Two-dimensional Echocardiographic Study of Left Ventricular Volume and Function in COPD Patients Admitted in Tertiary Care Hospital in Kolkata

Two-dimensional Echocardiographic Study of Left Ventricular Volume and Function in COPD Patients Admitted in Tertiary Care Hospital in Kolkata

The diastolic function abnormalities in hemodialysis session: a two-dimensional speckle tracking echocardiographic (2DSTE) study.

Hemodialysis (HD) decreases preload and its acute effect on the diastolic function is still controversial even with the introduction of new non-volume-dependent tissue Doppler echocardiographic indices. This study is designed to evaluate these acute changes following HD sessions. We enrolled 39 patients receiving standard thrice weekly HD for more than 6months and performed two dimensional speckle tracking echocardiography (2DSTE) and tissue Doppler studies with a standard cardiac ultrasound device shortly before and after HD. We observed significant changes in most of the transmitral flow and tissue Doppler echocardiographic parameters after HD. The left atrial volume index, left ventricular mass index, mitral E, mitral E/A, and lateral annular E/é levels decreased after HD (p: < 0.001, p: 0.026, p: < 0.001, p: 0.011, p: < 0.001, respectively). Medial á, medial myocardial performance index (MPI), medial ś, lateral ś, and lateral MPI values increased significantly after HD (p: 0.049, p: 0.007, p: 0.001, p: < 0.001, p: 0.01, respectively). Diastolic parameters like diastolic strain ratio early diastole (DSRE), diastolic strain ratio late diastole (DSRA), E/DSRE, and E/DSRA did not change significantly after HD (p: 0.716, p: 0.117, p: 0.114, and p: 0.211, respectively). The global longitudinal strain value obtained with 2DSTE worsened after HD (- 18.4 ± 4.0 before vs - 15.9 ± 5.4 after HD, p: 0.011). Transmitral flow and tissue Doppler parameters changed significantly after HD while the change in 2DSTE findings was not significant. The diastolic measurements made with 2DSTE may be less volume and cardiac preload dependent compared to conventional echocardiography and this may explain the difference.

Value of standard echocardiography at the bedside for COVID-19 patients in intensive care units: a Japanese single-center analysis.

PurposeIn the era of COVID-19, those special settings or indications for which standard transthoracic echocardiography (TTE) can safely produce benefits or advantages over minimized ultrasound imaging procedures need to be identified. Thus, the purpose of this study was to conduct a retrospective analysis with offline comprehensive conventional measurement of bilateral heart function and develop an appropriate prognostic model for in-hospital death.MethodsWe performed a retrospective analysis of 37 consecutive patients with COVID-19, confirmed by real-time reverse-transcriptase polymerase chain reaction assay, who had undergone clinically indicated standard two-dimensional echocardiographic studies in intensive care wards. Offline comprehensive measurement was also performed. We further integrated the echocardiographic findings as paired evidence of vital organ involvement (possible respiratory distress assessed using right ventricular functional parameters, possible myocardial injury assessed using increased wall thickness, effusion or asynergy) and circulatory failure (suspected low flow status assessed using stroke volume index, suspected congestion assessed using elevated right or left atrial pressure). We evaluated its value for in-hospital death along with other echocardiographic findings.ResultsThe most common features included a normal-sized left atrium and left ventricle with preserved left ventricular ejection fraction, despite deteriorated left ventricular flow volume. Less frequent findings, such as abnormalities in the right heart and left ventricular abnormalities suggesting myocarditis, were observed. Although the single echocardiographic parameters failed to show predictive values for in-hospital death, integration of the echocardiographic findings suggested predictive value (p = 0.04, odds ratio: 12.28).ConclusionStandard TTE at the bedside with offline comprehensive conventional measurement may provide prognostic information that is valuable for the management of patients with COVID-19.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10396-021-01122-1.

Impact of atrial septal defect device size on biventricular global and regional function: a two-dimensional strain echocardiographic study.

In this study, we assessed the acute changes in biventricular longitudinal strain after atrial septal defect transcatheter closure and its relation to the device size. Hundred atrial septal defect patients and 40 age-matched controls were included. Echocardiography and strain study were performed at baseline and 24 hours and 1 month after the intervention. The study group was divided into two subgroups; group 1: smaller devices were used (mean device size = 1.61 ± 0.05 cm, n = 74) and group 2: larger devices were used (mean device size = 2.95 ± 0.07 cm, n = 26). At baseline, there was a significant difference between the study group and controls as regards right ventricular global longitudinal strain with significant hyperkinetic apex (p = 0.033, p = 0.020, respectively). There was a significant immediate reduction in right ventricular global longitudinal strain (from -24.43 ± 0.49% to -21.62 ± 0.47%, p < 0.001), which showed insignificant improvement after 1-month follow-up. While only left ventricular global longitudinal strain increased after 1 month. Within 24 hours of device closure, all the basal- and mid-lateral segments strains and apical right ventricular strains showed a significant reduction. There was a significant negative correlation between the indexed large device size and an immediate change in the right ventricular global longitudinal strain (r = -0.425, p = 0.034). Significant right ventricular global longitudinal strain reduction starts as early as 24 hours after transcatheter closure, irrespective of the device size used. The rapid impact of closure was mainly on the biventricular basal and lateral segments and right ventricular apical ones, especially with the large sized atrial septal defect.

Frequency and risk factors of impaired left ventricular global longitudinal strain in patients with end-stage renal disease: a two-dimensional speckle-tracking echocardiographic study.

It has been identified that two-dimensional speckle-tracking imaging (2D-STI) enables the early detection of left ventricular (LV) systolic dysfunction. This study's objective was to evaluate the frequency of impaired LV global longitudinal strain (GLS) and investigate the factors in end-stage renal disease (ESRD) patients with preserved LV ejection fraction (LVEF) associated with the impaired GLS. A total of 100 ESRD patients with preserved LVEF who underwent transthoracic echocardiography (TTE) were studied. The GLS was calculated as the average of peak longitudinal strain from 18 myocardial segments obtained utilizing the three-standard apical imagings. According to a predefined cutoff, a GLS absolute value of less than 18% was considered subclinical LV systolic dysfunction. Impaired LV GLS <18% was detected in 58 participants (58/100, 58%). Multivariate analysis exhibited that increased LV mass index was independently associated with impaired GLS <18% [odds ratio (OR): 1.028, 95% confidence interval (CI): 1.004-1.052, P=0.020]. For sequential logistic regression models, model 1, based on parameters included in multivariate logistic regression (χ2=30.0), was improved by the addition of the LV mass index (χ2=37.4, P<0.01). The frequency of impaired LV GLS in ESRD patients with preserved LVEF was relatively high. An increased LVEF was independently associated with impaired LV GLS.

Myocardial strain in hypertension: a meta-analysis of two-dimensional speckle tracking echocardiographic studies.

Available evidence on systolic dysfunction in systemic hypertension, as assessed by left ventricular (LV) mechanics, is still based on single studies. Thus, we performed a systematic meta-analysis of two-dimensional speckle-tracking studies in order to provide an updated comprehensive information on this issue. The PubMed, OVID-MEDLINE, and Cochrane library databases were analyzed to search English language articles published from the inception up to 31 December 2020. Studies were identified by using MeSH terms and crossing the following search items: 'myocardial strain', 'left ventricular mechanics', 'speckle tracking echocardiography', 'systolic dysfunction', 'hypertensive heart disease', 'systemic hypertension', 'essential hypertension'. Data from 4276 individuals (2089 normotensive controls and 2187 mostly uncomplicated hypertensive patients) were included. Left ventricular (LV) mass index, relative wall thickness, left atrial volume index and E/e' ratio were significantly higher in hypertensive patients than in normotensive controls. LV ejection fraction did not differ in the two pooled groups (SMD -0.048 ± 0.054, 95% CI -0.20 to 0.10, P = 0.30), whereas LV global longitudinal strain (GLS) was significantly impaired in the hypertensive group (SMD: 1.07 ± 0. 15, 95% CI 0.77-1.36, P < 0.0001). Similar findings were obtained in a sub-analysis restricted to 15 studies in which mean age was similar in cases and controls (SMD 1.21 ± 0.23, 95% CI 0.76-1.67, P = 0.002). The present meta-analysis suggests that GLS assessment unmasks systolic dysfunction undetected by conventional ejection fraction in the uncomplicated hypertension setting and that this parameter should be incorporated into routine work-up aimed to identify hypertension-mediated cardiac damage.

Assessment of the left ventricular function in hypertensive pregnant women with or without proteinuria: two-dimensional versus four-dimensional echocardiographic study

Assessment of the left ventricular function in hypertensive pregnant women with or without proteinuria: two-dimensional versus four-dimensional echocardiographic study

Risk factors and prevalence of cardiac diseases in Egyptian pediatric patients with end-stage renal disease on regular hemodialysis

Cardiac disease is a significant cause of morbidity and mortality in children with end-stage renal disease (ESRD). The aim of this work was to study the risk factors and prevalence of cardiac diseases in Egyptian pediatric patients with ESRD under regular hemodialysis (HD). Sixty-six children with ESRD on regular HD were included and subjected to history, clinical, laboratory, chest X-rays (CXR), ECG, and two-dimensional echocardiographic study to measure different echocardiographic parameters focusing on the left ventricular ejection fraction. Ninety-two percent of the patients had a cardiovascular risk factor (62.1% hypertension, 37.9% anemia, 12.1% body mass index >95th percentile, 63% serum phosphorus >5.5 mg/dL, and 57.5% calcium-phosphorus product ≥55 mg2/dL2). A diagnosis of cardiac disease was reported in 16 (24.2%) of all studied patients, the diagnostic methods used were CXR in 39 (59 %), echocardiograms in 23 (34.8%), and electrocardiograms in 21 (31.8%), left ventricular hypertrophy/ enlargement was reported in 12 (75%) of cardiac patients, congestive heart failure/pulmonary edema in 11 (68.8%) of cardiac patients, cardiomyopathy in one (6.3%) of cardiac patients and decreased left ventricular function in one (6.3%) of cardiac patients. Ninety-two percent of patients had cardiovascular risk factors. Diagnosis of cardiac disease was reported in about a quarter of all studied patients. An echocardiography reported the left ventricular dysfunction in 12 (75%) of cardiac dialysis patients. The present study stresses the importance of echocardiography as the gold standard for the diagnosis of cardiac disease in pediatric patients under maintenance HD as a high-risk population for cardiac diseases.

Children with post-rheumatic valvulopathies in natural history: Five years follow-up

Rheumatic heart disease is the most important sequelae of acute rheumatic fever, which is caused by group A streptococci and usually presents in childhood, affecting 5 to 14 years old although it can strike people up to the age of 30. In poor and developing nations, it remains a major cause of morbidity and premature death, imposing a substantial burden on healthcare systems with limited budgets. The aim of the study was to investigate the pattern of lesions, the mortality and the challenges in five years follow-up in children with post rheumatic valvulopathies in natural history in the Cardiac Centre Shisong. This retrospective analysis included 270 patients aged between 5 and 16 years old having post rheumatic valvulopathies from July 2008 through July 2013. Data from patients’ records, two-dimensional echocardiographic studies, electrocardiogram were reviewed. Patients aged between 5 and 16 years old with a mean age of 12.4 ± 4.5 years. Female gender was representing 63% (n = 170) of the population. In 95 patients surgical correction could not be performed. Mitral regurgitation was the commonest echocardiographic diagnosis present in 61,5%, n = 164 patients; 38.5%, n = 103 patients had aortic regurgitation. Clinically, complications of the disease included congestive heart failure (n = 229, 85%), growth retardation (n = 162, 60%), sudden death (n = 27, 10%). Mortality in two years was 35%, (P ≤ 0.05, 95% CI = 2.5–6.5), in five years was 65% (P≤0.05, 93% CI = 2.7–7.21). The challenges faced are patients’ negligence and poor discipline, wrong beliefs, poverty. Post-rheumatic mitral valve regurgitation is the pathology the most encountered. Pulmonary hypertension is the most common echocardiographic complication of the disease. Five years mortality is very high in our setting. Due to financial limitation and illiteracy of parents, the follow-up of patients is difficult.

Correlation between NT pro-b-type Natriuretic peptide and left ventricular ejection fraction in children presenting with Dyspnea – a prospective cohort study

Introduction: Simple screening tests exist for congenital heart diseases but the same cannot be said for cardiac failure in children. Although echocardiography is considered the gold standard for the detection of left ventricular dysfunction, it is relatively expensive and is not often readily available. We aim to prove that NT pro-B-type natriuretic peptide levels may be useful in ruling out the diagnosis of heart failure in children presenting to the emergency room with dyspnea by studying the relation between left ventricular ejection fraction and NT pro-BNP. Methods: Seventy four patients presenting to the emergency department with dyspnea and fulfilling the modified Ross’ criteria for heart failure were included in the study. NT pro-BNP levels were measured for all the patients and a two-dimensional echocardiographic study was performed for them. Statistical analyses were performed using chi square test for independent samples and Pearson correlation tests. Results: A significant inverse correlation was observed between NT pro-BNP levels and left ventricular ejection fraction (r=-0.789, p=0.003). Conclusion: NT pro-BNP assay appears to hold promise as a potent and cost effective test of choice for acutely dyspneic children, which could replace chest x-ray and echocardiography as first investigation in such patients in urgent care settings.

Left Ventricular Myocardial Contractile Reserve during Exercise Stress in Healthy Adults: A Two-Dimensional Speckle-Tracking Echocardiographic Study

The aims of the present study were to determine left ventricular (LV) myocardial contractile reserve during exercise stress testing in healthy adults and to evaluate the effects of gender and age on exercise LV global longitudinal strain (GLS). The study population consisted of 67 healthy adults (age range, 23-80years; 49% women). Subjects were analyzed with respect to gender and predefined age groups (age<35years, n=18; age 35-55years, n=24; age>55years, n=25). All subjects underwent comprehensive echocardiographic assessment at rest and during symptom-limited semisupine exercise test. LV GLS was determined using two-dimensional speckle-tracking echocardiography. LV GLS magnitude during peak stress was 25.4±2.0%. The average absolute numeric LV GLS increase was 5.3%, equivalent to a relative 26.7% increase of LV GLS. LV GLS magnitude at peak exercise was without clinically significant differences between age groups (P=.07). No significant difference was found in peak exercise LV GLS between genders (P=.48). Linear regression analysis revealed a significant but weak correlation between peak LV GLS and age (r=-0.30, P=.02), whereas peak LV GLS was independent of maximal heart rate (r=0.23, P=.07), peak mean arterial blood pressure (r=-0.11, P=.38), body mass index (r=0.15, P=.22), and peak pulsed Doppler-derived cardiac index (r=-0.06, P=.67). LV GLS increases significantly during exercise stress in a healthy population. A dose-response relationship was found between LV GLS and exercise level independent of gender, and the influence of age appeared marginal. The technique is feasible, with low intra- and interobserver variability.

P1807Left atrial function in heart failure with mid-range ejection fraction differs from that of heart failure with preserved ejection fraction: a two-dimensional speckle tracking echocardiographic study

P1807Left atrial function in heart failure with mid-range ejection fraction differs from that of heart failure with preserved ejection fraction: a two-dimensional speckle tracking echocardiographic study

Echocardiographic profile of patients with cardiomyopathy

Introduction: Cardiomyopathies represent a heterogeneous group of diseases that often lead to progressive heart failure with significant morbidity and mortality. Exact epidemiological data on cardiomyopathy in Nepal are lacking. This study was done to observe the demographic and echocardiographic profile of patients with cardiomyopathy attending a medical college teaching hospital.&#x0D; Methods: Trans-thoracic two-dimensional echocardiographic study was performed by first author on all patients with cardiomyopathy over a period of six months. Patients’ demographic and echocardiographic data were collected and analyzed using SPSS version 20 software. Student t-test and Chi-square test were applied where appropriate.&#x0D; Results: A total of 60 patients were studied from October 2017 to March 2018. Mean age of all participants was 56.38 years (SD = 13.86). Mean age of males was significantly higher than that of females (60.96 yrs, SD = 13.61 versus 51.62 yrs, SD = 13.47) in dilated cardiomyopathy subgroup (p &lt; 0.05). Of all patients, 32 (53.33%) had dilated cardiomyopathy (idiopathic) and 13 (21.66%) had ischemic cardiomyopathy.&#x0D; Conclusion: Our study highlighted significant burden of dilated cardiomyopathy. Dilated cardiomyopathy appeared in females at earlier age compared to males. Potentially reversible cardiomyopathies like alcoholic and peripartum cardiomyopathies were also present which have a probability of cure if treated properly.

Morpho-functional cardiovascular adaptation in hypertensive patients: two-dimensional speckle tracking echocardiographic study.

Twenty-four-hour blood pressure (BP) variability is an important predictor of organ damage and cardiovascular events. Although epidemiological data are widely based on evaluation of office (clinic) BP, 24-hour ambulatory BP monitoring (ABPM) accurately assess the severity of hypertension to predict cardiovascular events in hypertensive patients, because it more accurately reflects BP load on heart and blood vessels. Conventional transthoracic echocardiography (TTE), such as M-mode and two-dimensional (2D), and more advanced techniques, such as tissue Doppler imaging (TDI) and speckle tracking echocardiography (STE), are used to identify pathological changes of the hypertensive heart disease. In addition, the study of systemic arterial compliance (SAC) predicts the impact of the arterial stiffness on the LV remodeling. Fifty-eight patients (34 males and 24 females, aged 53±12 years) with hypertension for at least one year were studied using Ambulatory Blood Pressure Monitoring (ABPM), with evaluation of 24-hour, day time, night time and sleep and awake average systolic and diastolic BP, and subsequently with TTE, to evaluate the influence of the 24-hour average BP, integrated with echocardiographic parameters, on cardiovascular adaptations in hypertensive patients. ECHO parameters examined were: left ventricle (LV) mass indexed to body surface area (LVMi), LV ejection fraction (EF), left atrial volume indexed to body surface area (LAVi), mitral inflow velocities (E, A and E/A), mitral annulus velocities (S' and E') and E/E' ratio by TDI, LV global longitudinal strain (GLS) using 2D STE. SAC was derived by the ratio SVi/PP, using echocardiographic stroke volume index to body surface area (SVi) and pulse pressure (PP). LVMi showed a correlation with the 24-hour average BP (SBP r=0.32; DBP r=0.26), SBPd (r=0.32), DBPd (r=0.28) and SBPn (r=0.29). GLS was correlated with the 24-hour average BP (SBP r=0.30; DBP r=0.32), SBPd (r=0.32), DBPd (r=0.32) and with LVMi (r=0.42), LAVi with 24 hour SBP (r=0.28), while SAC with LVMi (r=0.29) and LAVi (r=0.33). ABPM and TTE evaluation can be particularly useful in hypertensive patients, even with normal office BP, to highlight the influence of 24-hour blood pressure profile on LVM, and to a lesser extent, on LAV. SAC, instead, seems to be correlated both to LVM and LAV, independently of BP levels.

P1450Effect of overweight and obesity on left ventricular longitudinal multi-layer strain: a speckle tracking two-dimensional echocardiographic study

P1450Effect of overweight and obesity on left ventricular longitudinal multi-layer strain: a speckle tracking two-dimensional echocardiographic study

Is Left Atrial Function Affected by Coronary Slow Flow? A Two-dimensional Speckle-Tracking Echocardiographic Study.

Background:The coronary slow flow phenomenon (CSFP) is the slow passage of the angiographic contrast agent to the distal portion of the coronary artery in the absence of significant stenosis. We evaluated the left atrial (LA) function in patients with the CSFP using two-dimensional speckle-tracking echocardiography (2DSTE).Methods:The LA function was compared through 2DSTE between 36 patients with the CSFP and 36 participants with a normal coronary flow. The two groups were matched for age, sex, hypertension, diabetes mellitus, and the left ventricular function.Results:There were no statistically significant differences between the CSFP group and the control group regarding longitudinal systolic strain, early and late diastolic strains, and the strain rate of the LA myocardium.Conclusions:The LA function as evaluated with 2DSTE was not different between the CSFP group and the normal coronary flow group when they were matched for age, sex, hypertension, diabetes, and the left ventricular function.

Echocardiographic study of left ventricular structure and function in Nigerian patients with chronic liver disease

Background: The concept of cirrhotic cardiomyopathy includes impaired cardiac contractility, decreased beta-adrenergic receptor function, abnormal beta-adrenergic postreceptor function, defective excitation-contraction coupling, and cardiac conduction abnormalities. This study was aimed to assess the cardiac structure and function in adult Nigerians with chronic liver disease (CLD). Methods: This was a cross-sectional descriptive study of consecutive patients with CLD without any known cardiac disease attending the Liver Clinic of the Medical Out-patient Department of the University College Hospital. Apparently, normal individuals with comparable age and sex distribution were recruited as controls. The subjects and controls underwent two-dimensional, M-mode and Doppler echocardiographic studies to determine the cardiac structure in relation to both systolic and diastolic cardiac functions. Results: A total of 46 subjects and 50 normal controls were recruited. There was no difference in the blood pressure parameters of the two groups. The septal wall thickness was statistically higher in control, but this difference was lost when adjusted for body mass index. On the other hand, the adjusted left atrial diameter and aortic root dimension were statistically larger in the subjects than the controls. There was no difference in the left ventricular (LV) fractional shortening or ejection fraction, relative wall thickness, and deceleration time of the E-wave. Conclusions: We demonstrated an increase in cardiac index at rest in the subjects, but there was no significant difference in the LV diastolic or systolic dysfunction using traditional methods. Studies using newer modalities of the assessment of cardiac structure and function are needed in our environment.

Left Atrial Deformation Analysis in Patients with Corrected Tetralogy of Fallot by 3D Speckle-Tracking Echocardiography (from the MAGYAR-Path Study).

BackgroundThree-dimensional (3D) echocardiography coupled with speckle-tracking echocardiographic (STE) capability is a novel methodology which has been demontrated to be useful for the assessment of left atrial (LA) volumes and functional properties. There is increased scientific interest on myocardial deformation analysis in adult patients with corrected tetralogy of Fallot (cTOF).ObjectivesTo compare LA volumes, volume-based functional properties and strain parameters between cTOF patients and age- and gender-matched healthy controls.MethodsThe study population consisted of 19 consecutive adult patients with cTOF in sinus rhythm nursing at the University of Szeged, Hungary (mean age: 37.9 ± 11.3 years, 8 men, who had repair at the age of 4.1 ± 2.5 years). They all had undergone standard transthoracic two-dimensional Doppler echocardiographic study extended with 3DSTE. Their results were compared to 23 age- and gender-matched healthy controls (mean age: 39.2 ± 10.6 years, 14 men).ResultsIncreased LA volumes and reduced LA emptying fractions respecting cardiac cycle could be demonstrated in cTOF patients compared to controls. LA stroke volumes featuring all LA functions showed no differences between the 2 groups examined. LA global and mean segmental uni- and multidirectional peak strains featuring LA reservoir function were found to be diminished in adult patients with cTOF as compared to controls. Similarly to peak strains reduced global and mean segmental LA strains at atrial contraction characterizing atrial booster pump function could be demonstrated in cTOF patients as compared to controls.ConclusionsSignificant deterioration of all LA functions could be demonstrated in adult patients with cTOF late after repair.

Left ventricular stiffness predicts outcome in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation.

Assessment of the prognostic role of left ventricular stiffness (LVS) in patients with aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). We performed a complete two-dimensional transthoracic echocardiographic study before and after TAVI in patients with severe AS at high surgical risk. In order to assess LVS, we measured LV end-diastolic pressure (EDP) invasively during TAVI and LV end-diastolic volume (EDV) by means of echocardiography. We defined LVS as the EDV indexed by body surface area at an EDP of 20mmHg (EDVI20 ). Our aim was to assess the impact of LVS on one-year all-cause mortality after TAVI. One hundred sixty-six patients undergoing TAVI (64% female; mean age 82.7±5.1years) were enrolled. Seven patients died within the first 30days after TAVI and 21 within 1year. Overall follow-up duration was 580±478days. At multivariate analysis, independent predictors of 1-year all-cause mortality were moderate-to-severe paravalvular leak (PVL; HR 4.7, 95% confidence interval [CI] 1.9-11, P=.0003), female gender (HR 3.5, 95% CI 1.0-12, P=.045), and EDVI20 (HR 0.94, 95% CI 0.90-0.98, P=.015). In particular, patients with higher LVS (EDVI20 ≤48mL/m2 ) had a 1-year mortality of 26.9% vs 7.4% in patients with lower LVS (EDVI20 >48mL/m2 ; HR 4.2, 95% CI 1.6-10.6, P=.0007). Patients with higher LVS who developed moderate-to-severe PVL had the worst outcome (incremental chi-square test, P=.014). In patients with AS, an increased LVS has a negative prognostic impact. Development of significant PVL in patients with higher LVS had an incremental adverse effect.

Haemodialysis acutely deteriorates left and right diastolic function and myocardial performance: an effect related to high ultrafiltration volumes?

The effect of acute preload reduction during haemodialysis on left ventricle (LV) and right ventricle (RV) function is not well understood. This study aimed to evaluate acute changes in novel echocardiographic and tissue Doppler-derived indices of LV and RV function during the first and a standard weekly dialysis session and to examine the possible effect of acute intradialytic volume changes in LV and RV diastolic function and pulmonary circulation loading. Forty-one adult patients receiving standard thrice-weekly haemodialysis participated in this study. Two-dimensional echocardiographic and tissue Doppler imaging (TDI) studies were performed with a standard cardiac ultrasound device (Vivid 7 or Vivid e, GE, Horton, Norway) shortly before and after the first weekly and a standard dialysis session. Multiple linear regression analysis was applied to assess the effect of volume changes on peak early mitral (E) and tricuspid (E RV) velocities changes. Significant reductions from pre- to post-haemodialysis were noted in body weight and systolic blood pressure. Post-haemodialysis left and right atrial, LV and RV sizing echocardiographic parameters were lower. LV systolic function, represented by LV ejection fraction, cardiac output and mean peak systolic LV and RV velocities at the annulus level, was unchanged. Diastolic function indices such as E (first session: 0.96 ± 0.28 versus 0.75 ± 0.27 m/s, P < 0.001; standard session: 0.89 ± 0.24 versus 0.78 ± 0.29, P < 0.001) and E RV (first session: 0.89 ± 0.26 versus 0.67 ± 0.25 m/s, P < 0.001; standard session: 0.86 ± 0.24 versus 0.77 ± 0.31, P < 0.001), E/A LV ratio, TDI peak early mitral (E') velocity and E'/A' RV ratio were reduced after haemodialysis. Pulmonary circulation loading, represented by RV systolic pressure, was significantly improved. In multiple regression model analysis, intradialytic weight loss was independently associated with changes in E [β = 0.042 (95% CI 0.018-0.066)] and E RV [β = 0.084 (95% CI 0.057-0.110)]. This study shows that haemodialysis deteriorates cardiac diastolic function indices and improves pulmonary circulation loading, while systolic function remains unchanged. High intradialytic volume removal may affect cardiac diastolic function.