Assessment of right ventricular systolic functions in patients with chronic renal failure before and after hemodialysis

ABSTRACT Objective: In Chronic Renal Failure (CRF) patients treated with Hemodialysis (HD) preload is reduced due to the ultrafiltration during HD. In this study we aimed to determine the affect of preload change in right ventricular systolic function detected by new and old echocardiographic parameters in CRF patients and to determine whether the change in echocardiographic parameters is related to the amount of fluid taken. Methods : A total of 30 CRF patients (mean age 48 ± 15 years and 19 female) treated with HD at least 3 months were included in the study. In the echocardiographic evaluation of the patients; left ventricular ejection fraction (LVEF), left atrial (LA) volume, right atrial (RA) area, right ventricular (RV) end-diastolic area, pulmonary artery (PA) systolic pressure, right ventricular fractional area change (RV FAC), pulse wave Doppler (PW), tissue Doppler (TD), right ventricular myocardial performance index tended (RV MPI), right ventricular tissue Doppler S' (RV S') velocity, isovolumic myocardial acceleration (IVA) , tricuspid annular plane systolic excursion (TAPSE) and right ventricular outflow tract systolic excursion (RVOT SE) were recorded before and after HD. Results: LVEF values were increased and LA volume, RA area, RV end-diastolic area and PA systolic pressure decreased significantly after HD (p = 0.001). The RV MPI by PW, RV S' and RVOT SE parameters which are used to determine right ventricular systolic function did not change significantly after HD (p = 0548, p = 0942, p = 0.186). Meanwhile RV FAC, RV MPI by TD, IVA and TAPSE values were significantly increased (respectively p = 0.0001 and p = 0.001, p= 0.0001, p = 0.0001). Among parameters used in evaluation of right ventricular systolic function, TAPSE was found to be the only parameter that had a positive correlation with the amount of fluid ultrafiltrated (p = 0.041 and r = 0.375). Conclusions: This study demonstrated a decrease in preload in hypervolemic patients with normal left ventricular systolic function resulted in decreased size in heart chambers and increased systolic functions. Although RV MPI by PW, RV S' and RVOT SE were found to be independent of preload, RV FAC, RV MPI by TD, IVA and TAPSE values were dependent on the preload. In addition, TAPSE was found to be correlated with the amount of fluid taken. Keywords: Chronic renal failure, hemodialysis, right ventricular systolic function, echocardiography