Right ventricular dysfunction in patients with end-stage renal disease on regular hemodialysis

Abstract

Background Although there are considerable data on the changes in left ventricular function in hemodialysis (HD) patients, only a few studies on right ventricular (RV) function can be found in the literature. We investigated the changes in RV function in HD patients. MethodsWe examined 74 individuals grouped as follows: healthy controls (n=24) and HD patients (n=50). Echocardiography including tissue Doppler imaging (TDI) of the RV was performed in all patients. Results HD patients had significantly lower RV systolic indices than control participants in right ventricle fractional area change (normal 35-63%) (37.54±9.86 vs. 43.5±4.8%, P<0.001), tricuspid plane systolic excursion (normal 1.6-3 cm) (2.09±0.49 vs. 2.61±0.36 cm, P<0.001), STDISº wave (7.99±1.37 vs. 9.66±1.86 cm/s, P<0.001), and LTDISº wave (peak systolic velocity at lateral tricuspid annulus; normal: 10-19 cm/s) (11.86±2.86 vs.16.04±3.60, P<0.001). HD patients had statistically significantly higher systolic pulmonary pressure (normal<35 mmHg at rest) compared with those in the control group (32.75±10.11 vs. 25.23±3.99, P<0.001). There were no statistically significant correlations between systolic pulmonary pressure and RV dimensions or RV function indices. Conclusion Subclinical RV dysfunction - as estimated by RV function indices; tricuspid plane systolic excursion, right ventricle fractional area change, and LTDISº - is increased among HD patients. A high prevalence of pulmonary hypertension was found among HD patients and this was not associated significantly with RV or left ventricular dysfunction in these patients.

Keywords

• hemodialysis, pulmonary hypertension, right ventricular dysfunction