Preload reduction by a single hemodialysis unmasks abnormal left ventricular inflow jet dynamics and early diastolic incoordinate long axis motion in patients on maintenance hemodialysis

Abstract

Background. Our objective was to investigate changes in left ventricular inflow jet width and long axis motion in patients on maintenance hemodialysis by preload reduction due to a single hemodialysis.

Methods. We evaluated 20 patients on stable maintenance hemodialysis by Doppler echocardiography. Twenty age-matched controls were also examined. Transmitral flow, left ventricular long axis M-mode (LAM) echocardiography, and two-dimensional color Doppler early diastolic left ventricular inflow jet width (JW) were analyzed before and after a single hemodialysis.

Results. Before hemodialysis, compared with controls, JW was reduced in patients (2.1 ± 0.4 vs 2.4 ± 0.3 cm; P < 0.01), and early diastolic excursion of LAM (LAM-E) was also reduced. Peak velocity of the Doppler transmitral early diastolic wave (E) and late diastolic wave (A) were both higher, while the E/A ratio was lower. After hemodialysis, compared with the predialysis findings, JW and early diastolic excursion of LAM were unchanged; however, Doppler transmitral flow showed decreased E and E/A. Thus, in hemodialysis patients, inflow jet width was narrow, and unchanged by a single hemodialysis, while the Doppler transmitral flow pattern was changed mainly to dominant A waves and reduced E waves.

Conclusions. In patients on maintenance hemodialysis, the abnormal left ventricular inflow jet dynamics and early diastolic incoordinate long axis motion are unmasked by a preload reduction due to single hemodialysis in a different way from a transmitral Doppler flow pattern.