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The effect of hemodialysis-induced preload changes on the left ventricular function: a speckle-tracking echocardiographic study

Objective: This study aim to evaluate the effect of hemodialysis (HD)-induced preload changes on the left ventricular (LV) function in patients with chronic renal failure using LV imaging strain. Background: In dialysis patients, both cardiovascular and noncardiovascular mortality are significantly increased as compared with the general population. In particular, cardiovascular mortality contributes to 40% of all-cause mortality in patients on HD. Patients and methods: Twenty-six participants were enrolled in this study on maintenance HD three times per week for 3 h; they included 13 patients with hypertension, six with diabetes mellitus, and eight with ECG criteria of left ventricular hypertrophy. All participants underwent standard two-dimensional echocardiography and myocardial strain imaging. Results: There was a significant reduction of the stroke volume, the LV internal diameter in diastole, the LV internal diameter in systole, the LV posterior wall thickness in systole, the end-diastolic volume, the end-systolic volume, E wave, the E/A ratio, and finally the pulmonary artery systolic pressure after HD set (P < 0.05). In contrast, there were no significant changes in the interventricular septum in either diastole or systole, the LV posterior wall thickness in diastole, fractional shortening, A wave, the ejection fraction or left atrial dimensions (P > 0.05). Also, there was a significant reduction in the global longitudinal peak systolic strain in the long-axis view (GLPS_LAX) (−19.32 ± 4.30 to −16.58 ± 3.87), the global longitudinal peak systolic strain in the apical four-chamber view (GLPS_A4C) (−17.73 ± 4.76 to −15.98 ± 3.70), the global longitudinal peak systolic strain in the apical two-chamber view (GLPS_A2C) (−18.73 ± 4.22 to −16.79 ± 4.25), and the global longitudinal peak systolic strain average (GLPS_AVG) (−18.59 ± 3.96 to −16.45 ± 3.31) after HD set (P < 0.05). Conclusion: The preload reduction resulting from HD is associated with a reduction of the LV systolic function when assessed by the peak systolic longitudinal strain. This indicates preload dependence of the LV systolic function.