Effets de la réduction de la précharge sur les paramètres échographiques de la fonction systolique et diastolique du ventricule gauche de l’enfant en insuffisance rénale terminale : étude comparative avant et après hémodialyse

Purpose

Contrasting data exist about the hemodialysis induced changes of ventricular diastolic and systolic functions in adults. Few data in children with end-stage renal disease (ESRD) are reported. The aim of the present study was to evaluate the effect of a single hemodialysis (HD) session on left ventricular (LV) systolic and diastolic function using conventional pulsed-Doppler echocardiography and pulsed tissue Doppler imaging (TDI) in hemodialysis children.

Methods

Thirty-five children with chronic renal failure (15 males, aged 12.8 ± 3.8 years) on maintenance hemodialysis underwent conventional 2D and Doppler Echo together with measurement of longitudinal mitral annular motion velocities. Echocardiographic parameters were obtained 30 minutes before and 30 minutes after HD. Paired data were compared.

Results

Hemodialysis led to reduction in LV end-diastolic volume (p = 0.001), end-systolic volume (p = 0.05), left atrium area (p < 0.0001), peak early (E wave) transmitral flow velocity (p = 0.005), peak S velocity of pulmonary vein flow (p = 0.002), aortic time velocity integral (p < 0.0001) and aortic ejection time (p < 0.0001). No significant change in Tei Index was observed after HD. Regarding TDI measures, velocities were not affected by preload reduction. Only the early diastolic velocities on the septal side of the mitral annulus decreased significantly (p = 0.001) and the systolic velocities on the lateral side of the mitral annulus increased significantly (p = 0.042) after hemodialysis.

Conclusions

Most of Doppler-derived indices of diastolic function are preload-dependant. TDI velocities and Tei Index were not or minimally affected by preload reduction in hemodialysis children.