Early detection of cardiac involvement in hemodialysis patients

Background Cardiac involvement in hemodialysis patients is a serious condition with poor prognosis. The impact of chronic kidney disease and hemodialysis on heart function is not well understood. The transthoracic echocardiography (TTE) is performed when cardiac involvement is suspected. Recently, the development of (2D) strain imaging facilitated the simple and independent measurement of left ventricular (LV) deformation parameters in the longitudinal, circumferential and radial directions. Purpose To analyse LV systolic function in hemodialysis patients in two-dimensional (2D) TTE and with 2D speckle tracking (2D-STI) Methods Twenty-eight chronic hemodialysis patients were included prospectively from November 2017 to December 2017 at the Nephrology department. Twenty-one patients comprised the control group. Conventional 2D-TTE was performed followed by two-dimensional strain imaging (2D-STI). A complete TTE was conducted, including LVEF by Simpson biplane method, calculation of indexed left ventricular mass, analysis of Diastolic function with evaluation of filling pressures and finally the study of the longitudinal deformation of the LV (GLS) by the speckle tracking technique. Results The average age of patients in our sample was 49.7 ± 9.7 years with a sex ratio of 2,5. All patients were dialyzed 3 times a week with a mean duration of hemodiaylyse of 60 months. All patients had a conserved LVEF with a mean value of 60.3 ± 7%. The prevalence of LVH was 60.7%. Segmental kinetic disorders were found in 3 patients. The average value of GLS was −14.9 ± 3.2, which was impaired compared to that of the control group. GLS is decreased in 40% of the population. Conclusion The evaluation of longitudinal function by 2D strain gives a new insight into myocardial function in hemodialysis patients, which could improve pathophysiological understanding and identify patients at high risk of heart failure who can benefit from preventive strategies.