Abstract 14721: Noninvasive Assessment of Pulmonary Capillary Wedge Pressure and Left Ventricular Function Using Speckle Tracking Echocardiography Before and After Hemodialysis

IntroductionMost patients with hemodialysis have left ventricular (LV) remodeling by pressure and volume overload, resulting in heart failure. Evaluation of LV function is helpful in the treatment of dialysis patients. However, the direct impact of hemodialysis on LV systolic and diastolic function has not yet been fully and noninvasively evaluated.MethodsWe enrolled 123 dialysis patients (age66±11 years, 73 men). LV systolic function such as ejection fraction (EF), longitudinal strain and strain rate during systole (SR-S) were measured just before and after dialysis by speckle tracking echocardiography (STE). LV diastolic function such as E/e’, tau and stiffness were also calculated. LV systolic stress was calculated as pressure x dimension / thickness. Pulmonary capillary wedge pressure (PCWP) was estimated as 10.8 - 12.4 x log (left atrial active emptying function / left atrial minimum volume) as we previously reported. Tau was estimated as isovolumic relaxation time / (ln 0.9 x systolic blood pressure - ln PCWP). LV stiffness was estimated as diastolic stress / strain.ResultsSystolic blood pressure was significantly decreased after dialysis (152±24 to 140±24 mmHg) associated with water removal through dialysis session. There was no significant difference in LV mass between before and after dialysis (141±34 to 140±34 g/m). LV end-diastolic dimension and end-systolic dimension were decreased after dialysis (49±6 to 47±6 and 32±6 to 30±6 mm, respectively). LVEF, strain and SR-S were increased after dialysis (63±8 to 65±9 %, -17±4 to -18±5 and -1.0±0.2 to -1.1±0.2 s, respectively) associated with decreased LV systolic stress after dialysis (73±22 to 66±22 dynes/cm). E/e’ and PCWP were decreased (16±5 to 14±4, 10±3 to 8±3 mmHg, respectively), and tau and stiffness were improved after dialysis (48±9 to 46±9 msc, 0.9±0.7 to 0.6±0.5, respectively) associated with reduction of diastolic stress (12±5 to 9±4 dynes/cm).ConclusionsLV systolic and diastolic function was improved just after dialysis associated with decreased LV systolic and diastolic stress. Noninvasive evaluation of systolic and diastolic properties and PCWP could be performed in dialysis using STE and may have an incremental value in the treatment in dialysis patients.