Value of tissue Doppler imaging (TDI) in assessment of right ventricular function in patient with chronic renal failure on regular dialysis

Abstract

Cardiovascular complications are the main cause of death in patients with chronic kidney disease (CKD) undergoing hemodialysis therapy accounting for 40% of deaths in international registries (USRDS: Causes of death. Am J Kidney Dis, 1997). Hemodialysis (HD) which is usually carried out via a surgically created native arteriovenous fistula (AVF) has been associated with an increased risk of pulmonary hypertension (Abassi Z et al.,2006). On the other hand, AVF determines a chronic increase in preload which may impair right ventricular performance independently of post-load conditions. Moreover, most available studies focused their attention on left ventricular function in dialysis patients , the impact of dialysis treatments on right ventricle function has not fully been investigated. Our study was a prospective study that was designed to investigate the impact of chronic dialysis therapy on right ventricular function by echocardiography in patients with ESRD treated by regular hemodialysis. This was a prospective study conducted on ESRD patients on regular HD in the interval between May 2013 to December 2013 from both Ain Shams University Hospitals and Air Force Hospital. Study population consisted of 50 patients with ESRD treated with hemodialysis. The control group was consisted of 30 healthy subjects without history of cardiovascular or renal dysfunction . The groups were matched for age and sex .All subjects in the HD and control groups underwent detailed history and physical examination as well as electrocardiography (ECG). All patients were subjected to transthoracic echo Doppler study and tissue Doppler imaging to obtain he following parameters. Left ventricular systolic function, right side dimensions, right ventricle free wall thickness, right ventricle fractional area change FAC, tricuspid annular plane systolic excursion TAPSE, systolic excursion velocity at lateral tricuspid annulus (S wave), Doppler derived Tie index and tissue Doppler derived Tie index, then these parameters were compared between two groups, this study clearly showed that these parameters can be used successfully to asses right ventricular function in ESRD patients on HD. Right ventricular dimensions showed high significant difference between HD and control group (P value < 0.001). Right ventricular fractional area change showed significant difference between both groups with P value = 0.010, with prevalence of reduced FAC 48% (24 patients). The TAPSE showed high significant difference between both groups (P value < 0.001), with prevalence of reduced FAC 40% (20 patients). Doppler derived Tie index showed high significant difference between both groups (P value < 0.001), with prevalence of abnormal Tie index 76% (38 patients). Tissue Doppler derived Tie index showed high significant difference between both groups (P value < 0.001), with prevalence of abnormal tissue Doppler Tie index 80% (40 patients). Tissue Doppler S wave showed high significant difference between both groups (P value < 0.001), with prevalence of abnormal Tie index 84% (42 patients). In conclusion, RV dysfunction is highly prevalent among ESRD patients on regular hemodialysis therapy, with more prevalence of early detection using tissue Doppler parameters than conventional echo methods, Further studies are needed to explore the cause of RV dysfunction in HD patients and determine its impacts on patient’s survival.