The respiratory variations in mitral valve (MV) Doppler flow in hemodialysis (HD) patients have not been investigated and the normal echocardiographic value is used as a reference for HD patients. The present study evaluated the respiratory variation in MV Doppler flow in HD patients to determine if it has a unique pattern. In this prospective cohort study, echocardiography was performed before and 6 h after dialysis. The transmitral spectral Doppler E wave was measured during inspiratory and expiratory phases. The percent changes in the E wave were calculated pre- and post-dialysis. The means of the percent variation in the MV inspiratory and expiratory E wave pre- and post-dialysis were 56 ± 7% and 44 ± 1.1%, respectively, with a significant reduction after dialysis (P = .000). There was a significant positive correlation between post-dialysis ∆E wave % change and post-dialysis % change in weight (r = .318; P = .000). The respiratory changes in the MV E wave in HD patients were higher than the normal reference values. This marked variation could be explained by fluid overloading in HD patients.
de JagerDJGrootendorstDCJagerKJ, et al.Cardiovascular and non-cardiovascular mortality among patients starting dialysis. JAMA. 2009;302:1782-1789.
2.
LoutradisCSarafidisPAPapadopoulosCEPapagianniAZoccaliC. The Ebb and Flow of Echocardiographic Cardiac Function Parameters in Relationship to Hemodialysis Treatment in Patients with ESRD. J Am Soc Nephrol JASN. 2018;29:1372-1381.
3.
CozzolinoMManganoMStucchiACiceriPConteFGalassiA. cardiovascular disease in dialysis patients. Nephrol Dial Transplant. 2018;33:iii28-34.
4.
HarveyFArmstrongWFRyanT. Feigenbaum’s Echocardiography, 6th edn. Can J Cardiol. 2004;23:100-104.
5.
GinghinaCBeladanCCIancuMCalinAPopescuBA. Respiratory maneuvers in echocardiography: a review of clinical applications. Cardiovasc Ultrasound;7:42.
6.
EkinciCKaraborkMSiriopolDDincerNCovicAKanbayM. Effects of Volume Overload and Current Techniques for the Assessment of Fluid Status in Patients with Renal Disease. Blood Purification. 2018;46:34-47.
7.
FriedbergMKRedingtonAN. Right versus left ventricular failure: differences, similarities, and interactions. Circulation. 2014;129:1033-1044.
8.
KroekerCAShriveNGBelenkieITybergJV. Pericardium modulates left and right ventricular stroke volumes to compensate for sudden changes in atrial volume. Am J Physiol-Heart Circ Physiol. 2003;284:H2247-H2254.
9.
SarkarMBhardwajRMadabhaviIGowdaSDograK. Pulsus paradoxus. Clin Respir J. 2018;12:2321-2331.
10.
RehmanKABetancorJXuB, et al.Uremic pericarditis, pericardial effusion, and constrictive pericarditis in end-stage renal disease: Insights and pathophysiology. Clin Cardiol. 2017;40:839-846.
11.
NishimuraRA. Constrictive pericarditis in the modern era: a diagnostic dilemma. Heart Br Card Soc. 2001;86:619-623.
12.
OhJKTajikAJAppletonCPHatleLKNishimuraRASewardJB. Preload Reduction to Unmask the Characteristic Doppler Features of Constrictive Pericarditis. Circulation. 1997;95:796-799.
13.
SarafidisPAKamperidisVLoutradisC, et al.Haemodialysis acutely deteriorates left and right diastolic function and myocardial performance: an effect related to high ultrafiltration volumes?Nephrol Dial Transplant. 2017;32:1402-1409.
14.
DrighilAMadiasJEMathewsonJWEl MosalamiHEl BadaouiNRamdaniBBennisA. Haemodialysis: effects of acute decrease in preload on tissue Doppler imaging indices of systolic and diastolic function of the left and right ventricles. Eur J Echocardiogr. 2008;9:530-535.
15.
SadlerDBBrownJNurseHRobertsJ. Impact of hemodialysis on left and right ventricular Doppler diastolic filling indices. Am J Med Sci. 1992;304:83-90.
16.
FijalkowskiMKoprowskiAGruchalaM, et al.Effect of Preload Reduction by Hemodialysis on Myocardial Ultrasonic Characterization, Left Atrial Volume, and Doppler Tissue Imaging in Patients with End-stage Renal Disease. J Am Soc Echocardiogr. 2006;19:1359-1364.
17.
GrahamRJGelmanJSDonelanLMottramPMPeverillRE. Effect of preload reduction by haemodialysis on new indices of diastolic function. Clin Sci (Lond). 2003;105:499-506.
18.
AssaSHummelYMVoorsAA, et al.Changes in left ventricular diastolic function during hemodialysis sessions. Am J Kidney Dis. 2013;62:549-556.
19.
SimonneauGRobbinsIMBeghettiM, et al.Updated clinical classification of pulmonary hypertension. J Am Coll Cardiol. 2009;54:S43-S54.
20.
FathiRIsbelNHaluskaBCaseCJohnsonDWMarwickTH. Correlates of subclinical left ventricular dysfunction in ESRD. Am J Kidney Dis. 2003;41:1016-1025.
21.
HuntSAAbrahamWTChinMH, et al.Focused update incorporated into the ACC/AHA 2005 guidelines for the diagnosis and management of heart failure in adults a report of the American college of cardiology foundation/American heart association task force on practice guidelines developed in collaboration with the international society for heart and lung transplantation. J Am Coll Cardiol. 2009;53:e1-e90.
22.
ManciaGFagardRNarkiewiczK, et al.ESH/ESC guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013;31:1281-1357.
23.
BergströmJ. Ultrafiltration without dialysis for removal of fluid and solutes in uremia. Clin Nephrol. 1978;9:156-164.
24.
BornsteinAGaaschWHHarringtonJ. Assessment of the cardiac effects of hemodialysis with systolic time intervals and echocardiography. Am J Cardiol. 1983;51:332-335.
25.
VaziriNDPrakashR. Echocardiographic evaluation of the effect of hemodialysis on cardiac size and function in patients with end-stage renal disease. Am J Med Sci. 1979;278:201-206.
26.
DiptiASoucyZSuranaAChandraS. Role of inferior vena cava diameter in assessment of volume status: a meta-analysis. Am J Emerg Med. 2012;30:1414-1419.
27.
LyonMBlaivasMBrannamL. Sonographic measurement of the inferior vena cava as a marker of blood loss. Am J Emerg Med. 2005;23:45-50.
28.
SpevackRAl ShukairiMJayaramanDDankoffJRudskiLLipesJ. Serial lung and IVC ultrasound in the assessment of congestive heart failure. Crit Ultrasound J. 2017;9:7.
