Premium
Left atrial and ventricular systolic and diastolic myocardial mechanics in patients with end‐stage renal disease
Author(s) -
Calleja Anna M.,
Rakowski Harry,
Williams Lynne K.,
Jamorski Michal,
Chan Christopher T.,
Carasso Shemy
Publication year - 2016
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.13284
Subject(s) - diastole , cardiology , medicine , ejection fraction , diastolic function , heart failure , blood pressure
Background Diastolic cardiac dysfunction is an important complication of end‐stage renal disease ( ESRD ), but quantification remains a challenge. Given that diastolic dysfunction is reflected in both left atrial ( LA ) and ventricular ( LV ) function, we aimed to identify abnormalities in LV and LA volume and function using measures of myocardial mechanics. Methods We retrospectively studied 53 incident ESRD patients (46±16 y/o 44% male) and compared them to 85 normal controls. LA phasic volumes and functional parameters were obtained from the apical 4 CH view. Global ventricular peak longitudinal and circumferential strain, strain rate ( GLS , GL ‐ SR , CS ), and rotation were obtained from apical and short‐axis views. LA and LV measurements were taken off line using dedicated software (e S ie VVI ). Results ESRD patients had abnormal systolic function with lower LV ejection fraction and peak endocardial strain parameters (mean: GLS −16.6% vs −19.9%, GL ‐ SR −0.91 vs −1.04, and CS −25.6% vs 27.9%, P ≤.01 for all). Traditional Doppler parameters remained similar between groups, while diastolic mechanics were abnormal in ESRD . Reduced LV ‐derived diastolic parameters, fractional early reverse rotation, a marker of ventricular relaxation ( P <.006), and ratio of early diastolic SR to systolic SR ( P <.04) denote significant diastolic dysfunction. Increased LA volumes ( P <.001), decreased LA reservoir ( P <.001), conduit ( P <.0004), and contractile ( P <.02) function reflect diastolic dysfunction. Conclusion Myocardial strain measurements quantitated the abnormalities in both LV diastolic and LA function associated with the uremic state. The distinct abnormal diastolic parameters were suggestive of abnormal relaxation and increased filling pressures. Early and accurate assessment of diastolic function may help tailor patient management ESRD .