Abstracts $175 1097 Effect of hemodialysis on echocardiographic left ventricular parameters, lelt atrial volume and myocardial ultrasonic backscatter in patients with end-stage renal disease M. Fijalkowski 1, A. Koprowski 1, R. Galaska 1 A. Debska-Slizien 2 , J. Rogowski a, A. Rynkiewicz 1, B. Rutkowski 2. i Medical University of Gdansk, First Department of Cardiology, Gdansk; 2Medical Universi~ Department of Nephrology, Gdansk; 3Medical Universi~ Department of Cardiosurgery, Gdansk, Poland Hemodialysis (HD) reduces myocardial hypertrophy and volume overload. Ultra- sonic tissue characterization with cyclic variation of integrated backscalter (CVIBS) is noninvasive method lot assessment ol myocardial pedormance. Lelt atrial (LA) enlargement accompanies the development ol lelt ventricular diastolic dyslunction. Aim: To evaluate the effect of hemedialysis on echocardiographic Doppler param- eters, lelt atrial volume and CVIBS in patients with end-stage renal disease. Methods: We ~amined 25 patients with ESRD undergoing routine HD (age 54±16 years. 9 lemale) and 19 age-matched healthy volunteers (age 52±5 years. 4 female). Routine echocardiographic parameters, tissue Doppler ol mitral annu- lus. LA volume and CVIBS were measured in healthy volunteers and in patients with ESRD just belore and immediately alter HD. For CVIBS analysis two regions of interest were chosen in the parasternal LAX view: mid seplum and mid posterior wall. Results: Alter HD the E wave (85±33 vs 654-98 cnVs)the ratio of E/Era (10±4,5 vs 8,5±4) was significantly reduced and IRT (774-91 vs 844-96 ms) was increased. There was no significant dilferences between study groups wilh respect to TDI ol mitral annulus velocities (Em). HD significantly reduced LVD, LVS diameters and left ventricular mass (299±98 vs 273±107 g) and LA volume (85±33 vs 65±28 ml). CVIBS ol both intervetricular septum and posterior wall were significantly lower after HD than before HD. There was no significant dillerence ol CVIBS between patients with ESRD belore HD and healthy volunteers (Table 1). Table 1 Healthy Patients Patients p p p volunteers with ESRD with ESRD (healthy vs (healthy'vs (befor HD vs before HD pest HD before HD) after HD) afterHD) CVIBS septum (dB) 8,5±2,2 8,2±2,5 6,5±1.8 NS p<0.05 p<0.05 CVIB$ post. wall (dB) @,@±1,5 9,2±2,6 7,6±2,2 NS p<0.05 p<0.05 Conclusions: The present results demonstrate that HD reduced LVM and im- proved indices of the left ventricular diastolic performance estimated by echocar- diographic Doppler parameters. Interstitial edema could be responsible for "pseudonormalization" of ultrasonic myocardial characterization in patient with ESRD belore HD and the decrease in CVIBS might be caused by the reduction of myocardial interstitial edema after HD. Our results suggest that milral annu- lus velocities estimated by TDI represent less load-dependent markers ol diastolic function than mitral inflow parameters and LA volume. 1098 Effect of preload reducUon on indices of the heart diastolic function A. Minczykowski 1, D. Zaremba - Drobnik 2 , I. Pielrzak 2 , S. Czekalski 2, H. Wysocki 1. r Poznan University of Medical Sciences, Dept. of Cardiology-Intensive Therapy, Poznan, Poland; ePoznan University of Medical Sciences, Dept. of Nephrology, Poznan, Poland Objective: Characteristic changes in the transmitral Doppler flow pattern are seen in the presenceol impaired lelt ventricular filling. The aim of the present study was to e~amine the eflecl of preload reduction by haemodialysis on new echocardio- graphic indices of diastolic lunction. Patients and methods: Forty seven patients (age 50.0±17.1 years,28 males) on maintenance hospital haemodialysis (4 h three times a week) underwent echocar- diography approx. 30 min prior to, and approx. 30 min alter, a routine haemodial- ysis session. The aim ol fluid removal was to achieve a clinically determined "dry weight". A detailed 2D and Doppler examination was made to assess lell ventricu- lar (LV) structure and lunction including measurement of longitudinal mitral annular motion velocities by tissue Doppler imaging. Results: Haemodialysis resulted in a mean reduction in weight ol 2.1±0.6 kg. Following HD, there were significant reduction in left ventricular end-diastolic and end-systolic dimensions and left atrial diameter (LVIDd, 4.8±0.6 vs. 4.6±0.7 cm. p<0.0001. LVIDs, 3.4±0.7 vs. 3.2±0.8 cm, p<0.O001, LA, 4.2±0.7 vs. 3.8±0.8 cm, p<0.0001. Also consistent with a reduction in preload there was a reduc- tion in the peak early lraesmitral flow velocity (E, 97.7±29.3 vs. 75.6±26.9 cm/s. p<0.0001) and in the ratio of peak early filling velocity to peak late filling veloc- ity (E/A, 1.23±0.45 vs. 0.95±0.34, p<O.0OOl ). Following HD there were weak but significant decrease in mean early mitral annular velocity (11.8±3.2 vs. 11.2-1-~.7 cm/s, p=0.046) but there was no change after dialysis in the propagation velocity of mitral early diastolic filling (Vp, 49.6±19.1 vs. 48.2±17.8 cm/s, p>0.05). Tissue Doppler mitral annular late diastolic velocity (A') and the ratio ol early mitral an- nular velocity to late mitral annular velocity (EVA') did not change alter HD. The E/E' ratio decreased significantly alter HD (8.70±3.51 at baseline vs. 6.984-9.84 after HD, p<0.0001 ). There was no change after HD in isovolumic relaxation time (90.2-t-98.2 vs. 95.7±36.0 ms, p>0.05). Pulmonary venous flow peak systolic and diastolic forward velocities and peak atrial reversal velocity and duration remained unchanged alter dialysis in comparison with baseline. There were correlations be- tween E and a reduction in intravascular volume (r2=0.108, p=0.024). Conclusion: Preload reduction by haemodialysis has an influence on diastolic lunction. The transmitral early inflow velocity is strongly preload dependent while IVRT. pulmonary venous flow velocities, mitral A' annular velocity and Vp seem to be preload independent. 1099 The effect of every other day vs conventional haemodialysis on let ventricular function K. Pappas 1, K. Naka 1. I~ Nikolopoulos 2 , C. Gouva 2 . K. Kalopodis 2 , I.A. Goudevenos 1 , K. Siamopoulos 2 , L.K. Michalis 1. rUniversity ofloannina Medical School, Cardiology Dept., Michaelidion Cardiac Center, Ioannina, Greece; 2Universily of Icannina Medical School, Nephrology Dept., Icannina, Greece Lell venlricular (LV) hypertrophy and dysfunction are the main causes of psor car- diovascular outcome in end-stage renal disease patients on haemodialysis. Fluid and solute fluctuations during the week have an adverse elfect on cardiac lunction. Modifications ol haemodialysis schedules such as nocturnal and daily dialysis are used in order to overcome its adverse impact on cardiac function. Aim: To investigate the elfect ol every other day haemodialysis (eodHD; 15-16 sessions/month, equal intervals between haemodialysis sessions) vs conventional haemedialysis (cHD; 12-1,3 sessions/month) on cardiac function. Methods: Seventeen patients aged 60.2±10.3 (range 32-80) years, (11 males) on cHD for 87 (range 32-159) months were studied. Eight patients (group I) were transferred to an eedHD program, while the other 9 patients (group II) continued on the cHD schedule. Echesardiography was performed at baseline and at 12 months on a day out of haemodialysis (always on a midweek day). Ejection frac- lion (EF) and LV mass were measured using 2-D and M-mode echocardiography. Diastolic lunclion was assessed with conventional indices (E/A ratio. E decelera- lion time, isovolumic relaxation time) and new preload-independent indices using tissue Doppler imaging (E/Em) and color M-mode echocardiography (ENp). Tel index, an index of global cardiac function, was calculated lrom milral inflow and ejection time using Doppler echocardiography. Results: At baseline, demographic and clinical characteristics and echocardio- graphic indices ol systolic and diastolic lunction were similar between the groups. At 12 months, in the eodHD group, there was a decrease in LV mass compared to baseline (lrom 266±154 to 225±101 g, p<0.05), an increase in EF (from 54.6±8.1 to 69.8±5.9%, p<0.O001) and a decrease in Tel index (from 0.68±0.31 to 0.50±0.15, p<0.01), whereas in the cHD group, LV mass and Tel index remained unchanged (from 252±71 to 253±33 g and from 0.53±0.17 to 0.45±0.20, re- spectively, both p=ns), and EF decreased (from 59.1 ±6.3 to 54.9±4.7%, p<0.02). There were no significant changes in indices ol diastolic lunction in either group at lollow-up. Conclusion: In end-stage renal disease patients, every other day compared to conventional haemodialysis may have a lavorable impact on lelt ventricular hyper- trophy and on echocardiographic indices ol systolic and global cardiac lunction. while it does not appear to have an effect on indices ol diastolic function. Further research is needed to assess whether these changes are associated with an im- provement in patient prognosis. 1100 Effect o1 preload reduction by haemodialysis on the myocardial performance index (MPI) A. Minczykowski 1, D. Zaremba - Drobnik 2 , I. Pielrzak 2 , S. Czekalski 2 , H. Wysocki 1. ~ Poznan University of Medical Sciences, Dept. of Cardiology-Intensive Therapy, Poznan, Poland; 2 Poznan University of Medical Sciences, Dept. of Nephrology, Poznan, Poland Objective: Doppler echocardiographic MPI, defined as the sum ol isovolumic re- laxation (IVRT) and contraction (IVCT) time divided by ejection time (EjT), has been shown to reflect systolic as well as diastolic ventricular perlormance. Previ- ous studies have shown that the myocardial performance index is less alfected by age and by changes in heart rate and preload than conventional Doppler measure- ments, and therefore needs no correction for blood pressure, heart rate, preload or age. The aim ol the present study was to examine the elfect of preload reduction by haemodialysis on MPI. Patients and methods: Forty seven patients (age 50.0±17.1 years, 28 males) on maintenance hospital haemodialysis (4 h three times a week) underwent echocar- diography approx. 30 min prior to, and approx. 30 min alter, a routine haemodial- ysis session. The aim ol fluid removal was to achieve a clinically determined "dry weight". A detailed two-dimensional and Doppler examination was made to assess lell venlricular (LV) structure and lunction and to calculate MPI. Results: Haemodialysis resulted in a mean reduction in weight ol 2.1-{-0.6 kg. Following HD. there were significant reduction in left ventricular end-diastolic and end-systolic dimensions and lelt atrial diameter (LVIDd, 4.8±0.6 vs. 4.6+0.7 cm, p<0.00Ol, LVIDs, 3.4-1-0.7 vs. 3.2-1-0.8 cm, p<0.0001, LA, 4.2±0.7 vs. 3.8±0.8 cm, p<0.00Ol), consistent with a decrease in preload. Also consistent with a re- duction in preload there was a reduction in the peak early transmittal flow velocity (E, 97.7-1-29.3 vs. 75.6-1-26.9 cm/s, p<0.0001) and in the ratio ol peak early fill- ing velocity to peak late filling velocity (E/A, 1.23±0.45 vs. 095±0.34, p<0.0001). LV wall thickness and systolic increase in wall thickness did not change after HD. LV lraclional shortening and ejection lraction calculated by the Teichholz lormula did not change significantly in comparison with baseline. Doppler stroke volume as well as cardiac output decreased after HD (SV, 85.1±19.2 vs. 74.4+26.8 cm 3, Eur J Echocardiography Abstracts Supplement, December 2005 at University of Portland on May 20, 2011 ejechocard.oxfordjournals.org Downloaded from