Nguyen Thi Thu Hoai1,, Dang Thi Vu Dieu1, Doan Huu Linh1, Luu Thi Bich Dao2, Ngo Thi Huong2, Do Doan Loi3
1 Viện tim quốc gia Việt Nam, Bệnh viện Bạch Mai
2 Viện Tim mạch Quốc gia Việt Nam, Bệnh viện Bạch Mai
3 Khoa Tim mạch, Đại học Y Hà Nội

Nội dung chính của bài viết

Tóm tắt

Aims: To investigate right ventricular function in hemodialysis patients with preserved left ventricular ejection fraction (LVEF) using twodimensional speckle tracking echocardiography.

Methods: Patients with end-stage kidney disease (ESKD) who were on regular hemodialysis and had preserved LVEF and a group of age- and sex-matched control subjects were recruited for the study in Bach Mai Hospital. All subjects were interviewed and examined comprehensively. Echocardiography was performed in all patients and controls. Right ventricular function was evaluated using conventional and speckletracking echocardiography. Estimate glomerular filtration rate (eGFR) was calculated according to the MDRD GFR equation.

Results: From 6/2022 to 11/2022, a total of 61 ESKD receiving hemodialysis regularly and 32 controls were evaluated. The mean age of the hemodialysis patients was 51.2±13.8. Men account for 54.1% (33/61). Hemodialysis patients had larger right ventricular diameters, lower RV fractional area change (FAC) and tricuspid annular plane systolic excursion (TAPSE), and decreased S velocities of the tricuspid valve compared to the controls (p<0.05 for all). Systolic pulmonary artery pressure (sPAP) of the hemodialysis group was higher when compared to the controls (p<0.05 for all). Absolute values of right ventricular global strain (RVGS) and right ventricular free wall strain (RVFWS) were significantly lower in the hemodialysis group than in the control (p<0.05 for all). Absolute values of RVGS and RVFWS inversely correlated to LV mass index (r = -0.42, p<0.05 and r=-0.46, p<0.05, respectively) while they positively correlated to eGFR (r = 0.57, p<0.05 and r = 0.59, p<0.05, respectively), hemoglobin level (r = 0.41, p<0.05 and r = 0.43, p<0.05, respectively), RVFAC (r = 0.54, p<0.05 and r = 0.51, p<0.05, respectively).

Conclusion: Right ventricular function assessed by speckle tracking echocardiography reduced in hemodialysis patients. Right ventricular myocardial strain strongly correlated with glomerular filtration rate, RVFAC, and moderately correlated with hemoglobin level and LV mass index..

Chi tiết bài viết

Tài liệu tham khảo

1. Tonelli, M.; Karumanchi, S.A.; Thadhani, R. Epidemiology and Mechanisms of Uremia-Related Cardiovascular Disease. Circulation 2016, 133, 518–536.
2. Unger, E.D.; Dubin, R.F.; Deo, R.; Daruwalla, V.; Friedman, J.L.; Medina, C.; Beussink, L.; Freed, B.H.; Shah, S.J. Association of chronic kidney disease with abnormal cardiac mechanics and adverse outcomes in patients with heart failure and preserved ejection fraction. Eur. J. Heart Fail. 2016, 18, 103–112.
3. Lang, R.M.; Badano, L.P.; Mor-Avi, V.; Afilalo, J.; Armstrong, A.; Ernande, L.; Flachskampf, F.A.; Foster, E.; Goldstein, S.A.; Kuznetsova, T.; et al. Recommendations for cardiac chamber quantification by echocardiography in adults: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J. Am. Soc. Echocardiogr. 2015, 28, 1–39.e14.
4. Hoai Thi Thu Nguyen, Chien Van Do, Dieu Thi Vu Dang, Loi Doan Do, Linh Huu Doan, Ha Thi Viet Dang. Progressive alterations of left atrial and ventricular volume and strain across chronic kidney disease stages: a speckle tracking echocardiography study. Frontiers in Cardiovascular Medicine. Sec. Heart Valve Disease. Volume 10 September 2023. https://doi.org/10.3389/fcvm.2023.1197427
5. Morris, D.A.; Krisper, M.; Nakatani, S.; Köhncke, C.; Otsuji, Y.; Belyavskiy, E.; Radha Krishnan, A.K.; Kropf, M.; Osmanoglou, E.; Boldt, L.H.; et al. Normal range and usefulness of right ventricular systolic strain to detect subtle right ventricular systolic abnormalities in patients with heart failure: A multicentre study. Eur. Heart J. Cardiovasc. Imaging 2017, 18, 212–223. 27
6. Karavelioglu Y, Ozkurt S and Kalcik M. Echocardiographic assessment of right ventricular function in nondiabetic normotensive hemodialysis patients. Interventional Medicine & Applied Science. 2015; 7(3):95–101.
7. Tamulėnaitė E, Zvirblyte R, Ereminiene R, et al. Changes of left and right ventricle mechanics and function in patients with end-stage renal disease undergoing haemodialysis. Medicina. 2018; 54(5):87.
8. Ali HA, Mohamad NA, Mohammad HS, et al. 2D speckle tracking in the assessment of left and right ventricular functions in hemodialysis versus recently diagnosed uremic patients with preserved systolic function. The Egyptian Journal of Critical Care Medicine. 2016;4(3):139-44.
9. El-deen MB and George SK. Right ventricular functions in hemodialysis patients: tissue doppler study. Med. J. Cairo Univ. 2015;83(2):385-91. 10. Tasana A., Burlacu A., Popa I et al. Right Ventricular Functionality Following Hemodialysis Initiation in End-Stage Kidney Disease - A Single-Center, Prospective, Cohort Study. Medicina (Kaunas) 2021 Jul 10;57(7):704. doi: 10.3390/medicina57070704.