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

ABSTRACT

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 6 months 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 s, lateral s, 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.