Abstract
The prevalence of the left ventricular hypertrophy (LVH) is very high in end-stage renal disease treated by hemodialysis. Diastolic dysfunction is a frequent consequence and leads to the development of heart failure with preserved ejection fraction. New American/European echocardiographic guidelines for the assessment of diastolic function simplified the evaluation and were published recently. The aim of this study was to reveal if the new guidelines stratify asymptomatic hemodialysis patients by the levels of brain-natriuretic peptide (BNP). A cohort of 46 patients hemodialyzed in one center with the lack of overt heart failure, systolic dysfunction, arrhythmia or significant valvular disease were examined by echocardiography before and after a single hemodialysis and blood samples for BNP analysis were drawn at both occasions. The LVH was present in 53% of patients, concentric remodeling in another 17%. Higher indexed left ventricular mass was related to higher BNP levels (r = 0.58, p = 0.0001). Before hemodialysis, diastolic dysfunction was present in 61%: grade 1 in 25%, grade 2 in 21% and grade 3 in 8%. The higher grade of diastolic dysfunction was associated with the incremental increase of BNP. The post-dialysis echocardiography did not allow the assessment of diastolic function in as many as 37% of patients. Our study has shown that the application of the current guidelines for the assessment of diastolic function based on simple four criteria differentiate hemodialysis symptomless patients with preserved systolic function according to BNP levels. BNP levels also rose together with the left ventricular mass. The ratio E/eʹ medial seemed to be a better predictor of increased BNP than E/eʹ lateral or E/eʹ averaged.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Malik J (2018) Heart disease in chronic kidney disease—review of the mechanisms and the role of dialysis access. J Vasc Access 19(1):3–11
Foley RN et al (2010) Left ventricular hypertrophy in new hemodialysis patients without symptomatic cardiac disease. Clin J Am Soc Nephrol 5(5):805–813
Dolan M, Whipp B, Wasserman K, Davidson W Cause of hypoxemia during hemodialysis. (1981) N Engl J Med 305(22):1351–1352
Antlanger M et al (2017) Heart failure with preserved and reduced ejection fraction in hemodialysis patients: prevalence, disease prediction and prognosis. Kidney Blood Press Res 42(1):165–176
Nagueh SF et al (2016) Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 17(12):1321–1360
Reque J et al (2017) Pulmonary hypertension is associated with mortality and cardiovascular events in chronic kidney disease patients. Am J Nephrol 45(2):107–114
Malik J et al (2016) Left atrial dysfunction in end-stage renal disease patients treated by hemodialysis. Nephron 133(3):169–174
Krupicka J et al (2009) Natriuretic peptides—physiology, pathophysiology and clinical use in heart failure. Physiol Res 58(2):171–177
Celik G et al (2012) Plasma BNP, a useful marker of fluid overload in hospitalized hemodialysis patients. Hemodial Int 16(1):47–52
Agarwal R (2013) B-type natriuretic peptide is not a volume marker among patients on hemodialysis. Nephrol Dial Transplant 28(12):3082–3089
Ouali S et al (2011) Relationship of brain natriuretic peptide concentrations to left ventricular function and adverse outcomes in children with end-stage renal disease undergoing hemodialysis. Pediatr Cardiol 32(5):568–577
Melenovsky V et al (2015) Left atrial remodeling and function in advanced heart failure with preserved or reduced ejection fraction. Circ Heart Fail 8(2):295–303
Lang RM et al (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 16(3):233–270
Hickson LJ et al (2016) Echocardiography criteria for structural heart disease in patients with end-stage renal disease initiating hemodialysis. J Am Coll Cardiol 67(10):1173–1182
Pellicori P, Cleland JG (2014) Heart failure with preserved ejection fraction. Clin Med (Lond) 14(Suppl 6):s22–8
Fang JC (2016) Heart failure with preserved ejection fraction: a kidney disorder? Circulation 134(6):435–437
Sanjuan R et al (2011) Plasma brain natriuretic peptide levels in cardiac function assessment in chronic dialysis patients. Cardiorenal Med 1(3):147–155
Kimura H et al (2011) Left ventricular mass index is an independent determinant of diastolic dysfunction in patients on chronic hemodialysis: a tissue Doppler imaging study. Nephron Clin Pract 117(1):c67–c73
Foley RN et al (1995) The prognostic importance of left ventricular geometry in uremic cardiomyopathy. J Am Soc Nephrol 5(12):2024–2031
Leifheit-Nestler M et al (2016) Induction of cardiac FGF23/FGFR4 expression is associated with left ventricular hypertrophy in patients with chronic kidney disease. Nephrol Dial Transplant 31(7):1088–1099
Funding
This study was supported by the grant of the Agency of Health Research of the Czech Republic 17-31796A.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Malik, J., Kudlicka, J., Valerianova, A. et al. Diastolic dysfunction in asymptomatic hemodialysis patients in the light of the current echocardiographic guidelines. Int J Cardiovasc Imaging 35, 313–317 (2019). https://doi.org/10.1007/s10554-019-01564-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10554-019-01564-2