Assessment of left ventricular diastolic function by pulsed Doppler echocardiography in chronic hemodialysis patients

The left ventricular (LV) diastolic dysfunction, as well as systolic dysfunction, has been considered to play an important role in the pathogenesis of the cardiac failure in chronic hemodialysis (HD) patients. To determine whether HD patients have impaired LV diastolic performance, we evaluated the LV diastolic function using pulsed Doppler echocardiography in 13 HD patients (HD group: 5 males, 8 females, mean age 55±9 years) and in 6 healthy subjects (control group: 4 males, 2 females, mean age 48±11 years). The transmitral velocity pattern has two wave components: one in the rapid filling phase (R wave) and the other in the late diastolic phase (A wave). The peak rapid filling velocity (R), the peak atrial filling velocity (A), and the ratio of R to A (A/R) were measured from the velocity pattern. Since the transitral velocity pattern is affected by LV diastolic function and the cardiac preload, it was quite important to obtain an accurate parameter for the volume status. For this, we applied a Swan-Ganz thermodilution ejection fraction/volumetric catheter during HD in 5 patients, and the right ventricular end-diastolic volume index (RVEDVI) was calculated using the thermodilution washout curve. The A/R ratio was significantly higher in the HD group than in the control group (0.90±0.09 vs 1.21±0.30, p