Diagnosis ofleft-ventricular diastolic dysfunction in patients with pre-di-alysis chronic renal failure


Cite item

Full Text

Abstract

Aim. To specify effectiveness of different methods for assessment of diastolic function in patients with
pre-dialysis chronic renal failure (CRT).
Material and methods. Forty non-diabetic pre-dialysis СRFpatients (20 males and 20 females, mean
age 51 ± 11 years) were studied. Serum creatinine was 209.3 ± 117.4 mcmol/l. 19 patients had
chronic heart failure (CHF) of NYHA class l-lll. M-mode echocardiography and Doppler echocardiography
were performed. Transmitral and pulmonary venous flows were assessed by Doppler echocardiography
and the flow propagation velocity (Vp) was estimated by color M-mode Doppler echocardiography.
The ratio of peak E-wave velocity of transmitral flow to Vp (E/Vp) was calculated. All the
patients had preserved systolic function (ejection fraction > 45%).
Results. Interpretation of transmitral flow was difficult in 16 (40.0%) patients. During Valsalva's manoeuvre
the E-wave peak velocities, the A-wave velocities and the ratio E/A were decreasing. However,
we did not reveal any correlation between E/A and NYHA class of heart failure (r = 0.18;
p = 0.32). Interpretation of pulmonary venous flow was possible only in 24 (60.0%) patients. Vp estimation
by color M-mode Doppler echocardiography improved evaluation of diastolic function in 15 of
16 patients with problems of transmitral flow assessment. A negative correlation was revealed between
NYHA class and Vp (r = -0.39; p = 0.013) and a positive correlation was between NYHA class and
E/Vp (r = 0.45; p = 0.004).
Conclusion. Vp assessed by color M-mode Doppler echocardiography improves the diagnosis of diastolic
dysfunction in patients with chronic renal insufficiency. This method has an advantage over pulmonary
venous flow investigation. The Valsalva's manoeuvre is low-effective for differential diagnosis of
transmitral flow types.

References

  1. States Renal Data System. USRDS 1999 Annual Data Report. National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. Bethesda, MD; 1999.
  2. Рекомендации по диагностике и лечению хронической сердечной недостаточности. Доклад экспертной группы Европейского общества кардиологов. Сердеч. недостаточность 2001; 6: 251-276.
  3. Шутов А. М., Куликова Е. С., Кондратьева Н. И. и др. Гипертрофия левого желудочка у больных в додиализном периоде хронической почечной недостаточности, не связанной с сахарным диабетом. Нефрология 2001: 2: 49-53.
  4. Smiseth О. A. Assessment of ventricular diastolic function.Can. J. Cardiol. 2001; 17: 1167-1176.
  5. Шутов А. М., Куликова Е. С., Ивашкина Т. Н. и др. Влияние анемии на диастолическую функцию левого желудочка у больных с хронической почечной недостаточностью. Кардиология 2001; 5: 60.
  6. Шутов А. А., Кондратьева Н. И., Ивашкина Т. Н. и др. Диастолическая дисфункция и клинические проявления сердечной недостаточности у больных с додиализной хронической почечной недостаточностью. Нефрология 200Г. 5: 30-35.
  7. Sahn D. J., DeMaria A., Kissio J., Weyman A. Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation 1978; 58: 1072-1083.
  8. Schiller N. В., Shan P. M., Crawford M. et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. J. Am. Soc. Echocardiogr. 1989; 2: 358 - 367.
  9. Devereux R. В., Alomso D. R., Littas E. M. et al. Echocardiographic assessment of left ventricular hypertrophy comparison to necropsy findings. Am. J. Cardiol. 1986; 57: 450-458.
  10. Abeigel E., Tase M., Bohlader J. Which definition for echocardiographic left ventricular hypertrophy? Ibid. 1995; 75: 486- 503.
  11. Ganau A., Devereux R. В., Roman M. J. et al. Patterns of left ventricular hypertrophy and geometric remodeling in essential hypertension J. Am. Coll. Cardiol. 1992; 19: 1550-1558.
  12. Wijbenga A. A. M., Mosterd A., Kasprzak J. D. et al. Potentials and limitations of the Valsalva maneuver as a method of differentiating between normal and pseudonormal left ventricular filling patterns. Am. J. Cardiol. 1999; 84: 76-81.
  13. Garcia J. M., Ares A. M., Asher C. et al. An index of early left ventricular filling that combined with pulsed Doppler peak E velocity may estimate capillary wedge pressure. J. Am. Coll. Cardiol. 1997; 29: 448-454.
  14. European Studv Group on Diastolic Heart Failure. How to diagnose diastolic heart failure. Eur. Heart J. 1998; 19: 990- 1003.
  15. Young E. W., Carroll L. E., Wolfe R. A. et al. Trends in comorbidity and residual renal function in patients starting treatment foe end-stage renal disease. J. Am. Soc. Nephrol. 1995; 6: 897.
  16. Harnett J. D., Foley R. N., Kent G. M. et al. Congestive heart failure in dialysis patients: Prevalence, incidence, prognosis, and risk factors. Kidney Int. 1995; 47: 884-890.
  17. Oxenham H., Sharpe N. Prognostic stratification in heart failure: what's the point? Eur. Heart J. 2000; 21:1815-1816.
  18. Parthenakis F. I., Kanonpakis E. M., Kochiadakis G. E. et al. Left ventricular diastolic filling pattern predicts cardiopulmonary determinations of functional capacity in patients with congestive heart failure. Am. Heart J. 2000; 140: 338-344.
  19. Nijland F., Kamp O., Karreman A. J. P. et al. Prognostic implications of restrictive left ventricular filling in acute myocardial infarction: A serial Doppler echocardiographic study. J. Am. Coll. Cardiol. 1997; 30: 1618-1624.
  20. Pozzoli A., Traversi E., Coiffi G. et al. Loading manipulations improve the prognostic value of Doppler evaluation of mitral flow in patients with chronic heart failure. Circulation 1997; 95: 1222-1230.
  21. Неласов Ю. Н., Кастанаян А. А. К вопросу о модификации канадской классификации диастолической дисфункции левого желудочка. Сердеч. недостаточность 2000; 2: 54- 55.
  22. Овчинников А. Г., Агеев Ф. Т., Мареев В. Ю. Методические аспекты применения допплерэхокардиографии в диагностике диастолической дисфункции левого желудочка. Там же. 66-70.
  23. Smiseth О. A., Thompson С. R. Atrioventricular filling dynamics, diastolic function and dysfunction. Heart Fail. Rev. 2000; 5: 291-299.
  24. Cohen G. I., Pietrolungo J. F, Thomas J. D., Klein A. L. A practical guide to assessment of ventricular diastolic function using Doppler echocardiography. J. Am. Coll. Cardiol. 1996; 27: 1753-1760.
  25. Енькшш Т. И., Лукичев Б. Г., Енькин А. А., Гринев К. М. Влияние шунтового кровотока по артериовенозной фистуле на развитие сердечной недостаточности у больных с хронической почечной недостаточностью, корригированной программным гемодиализом. Нефрология 2000; 1: 48-52.
  26. Dumesnil J. G., Gaudreault G., Honos G. N., Kingma J. G. Use of Valsalva maneuver to unmask left ventricular diastolic function abnormalities by Doppler echocardiography in patients with coronary artery disease or systemic hypertension. Am. J. Cardiol. 1991; 68: 515-519.
  27. Wijbenga A. A. M., Mosterd A., Kasprzak J. D. et al. Potentials and limitations of the Valsalva maneuver as a method of differentiating between normal and pseudonormal left ventricular filling patterns. Ibid. 1999; 84: 76-81.
  28. Moller J. E., Paulsen S. H., Sondergaard E., Egstrup K. Preload dependence of color M-mode Doppler flow propagation velocity in control and in patients with left ventricular dysfunction.J. Am. Soc. Echocardiogr. 2000; 13: 902-909.
  29. Wachtell K., Smith G., Gerdts E. et al. Left ventricular filling patterns in patients with systemic hypertension and left ventricular hypertrophy (the LIFE study). Am. J. Cardiol. 2000; 85: 466-472.
  30. Сумин А. Н. Ранняя реабилитация больных с различными формами хронической сердечной недостаточности (использование электрокардиостимуляции скелетных мышц, статико-динамических нагрузок, поведенческих воздействий): Автореф. дис. ... д-ра мед. наук. Новосибирск; 1999.
  31. Nishimura R. A., Tajik A. J. Evaluation of diastolic filling of left ventricle in health and disease: Doppler echocardiography is the clinician's ROSETTA STONE: J. Am. Coll. Cardiol. 1997: 30: 8-18.
  32. Parthenakis F. I., Kanonpakis E. M., Kochiadakis G. E. et al. Left ventricular diastolic filling pattern predicts cardiopulmonary determinations of functional capacity in patients with congestive heart failure. Am. Heart J. 2000; 140: 338-344.
  33. Poulsen S. H., Jensen S., E., Egstrup K. Longitudinal changes and prognostic implications of left ventricular diastolic function in first acute myocardial infarction. Ibid. 1999: 137: 910- 918.
  34. Garcia M. J., Smedira N. G., Greenberg N. L. et al. Color M- mode Doppler flow propagation velocity is a preload insensitive index of left ventricular relaxation: Animal and human validation. J. Am. Coll. Cardiol. 2000; 35: 201-208.
  35. Moller J. E., Sondergaard E.. Sevard J. B. et al. Ratio of left ventricular peak E-wave velocity to flow propagation velocity assessed by color M-mode Doppler echocardiography in first myocardial infarction. Ibid. 363-370.
  36. Stugaard M., Smiseth O. A., Risoe C., Men H. Intraventricular early diastolic filling during acute myocardial ischemia: assessment by multigated color M-mode Doppler. Circulation 1993; 88: 2705-2713.
  37. Garcia M., Palac R., Malenka D. et al. Color M-mode flow propagation velocity is a relatively preload-independent index of left ventricular filling. J. Am. Soc. Echocardiogr. 1999; 12: 129-137.
  38. Vierendeels J. A., Dick E., Verdonck P. R. Hydrodynamics of color M-mode Doppler flow wave propagation velocity V(p): A computer study. Ibid. 2002; 15: 219-224.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2003 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
 

Address of the Editorial Office:

  • Novij Zykovskij proezd, 3, 40, Moscow, 125167

Correspondence address:

  • Alabyan Street, 13/1, Moscow, 127055, Russian Federation

Managing Editor:

  • Tel.: +7 (926) 905-41-26
  • E-mail: e.gorbacheva@ter-arkhiv.ru

 

 © 2018-2021 "Consilium Medicum" Publishing house


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies