The Effect of Preload Reduction on Parameters to Evaluate Left Ventricular Diastolic Function

BACKGROUND AND OBJECTIVES: The pulsed wave Doppler echocardiography in the mitral inflow is known to be affected by several factors, such as the loading condition. The mitral annulus velocity and early diastolic flow propagation velocity(Vp) are known to be relatively load independent. Recently, the time interval between the onsets of mitral inflow and mitral annulus velocity(TE'-E) has been proposed as a new index representing left ventricular(LV) relaxation and related to LV filling pressure. This index has been reported as a preload independent parameter in experimental canine model. The impact of preload on this index, however, has not been studied in human. The purpose of this study was to evaluate the effect of the hemodialysis related preload reduction on conventional and new Doppler indices of LV diastolic function. SUBJECTS AND METHODS: Forty five patients(29 men, mean 51±14 years old) who have end stage renal disease underwent echocardiography immediately before and after hemodialysis(HD). Two dimensional and Doppler parameters including peak early(E) and late(A) transmitral inflow velocity were measured. Mitral annulus velocity(E’) at septal, lateral, anterior, and inferior corners of the mitral annulus by Doppler tissue imaging(DTI) and Vp by color M-mode were also measured. The Time intervals between peak of R wave and onset of mitral E velocity and between peak R wave and onset of E' at the four corners of the mitral annulus were measured. RESULTS: The mean ejection fraction was 62 ± 16 %. Average weight reduction by HD was 2.9 ± 1.1 kg. The dimensions of LV end diastole, left atrium and inferior vena cava were reduced significantly as 2.4 ± 2.7, 2.3 ± 4.7, and 4.8 ± 4.5 mm, respectively(p < 0.001). After HD, the peak E(from 99.4 ± 33.0 to 70.6 ± 26.3 cm/s, p < 0.001), A(from 94.3 ± 24.6 to 84.8 ± 29.0 cm/s, p = 0.001), E/A ratio(from 1.1 ± 0.6 to 1.0 ± 0.8, p = 0.041), the average peak E’(from 10.0 ± 3.3 to 9.0 ± 3.5 cm/s, p = 0.001) and Vp(from 48.5 ± 15.2 to 40.2 ± 14.4 cm/s, p = 0.008) decreased significantly. T_(E’-E) did not change significantly after HD regardless of LV systolic function. CONCLUSION: Volume reduction typically affects mitral inflow velocities in patients undergoing hemodialysis. However, a new parameter for diastolic function, time interval between the onset of mitral inflow and mitral annulus velocity appears to be preload independent in patients with normal or decreased LV systolic function.

Author dc:creator

• 유, 상용

Contributors dc:contributor

• 탁, 승제
• 대학원 의학과
• 199924327

• 도플러 심초음파
• 이완기
• 혈액투석
• Doppler echocardiography
• diastole
• hemodialysis

Language dc:language

ko

Identifier

http://dcoll.ajou.ac.kr:9080/dcollection/jsp/common/DcLoOrgPer.jsp?sItemId=000000000666
000000000666

OAI identifier oai:identifier

oai:repository.ajou.ac.kr:201003/1499