The Effect of Ultrafiltration and Hemodialysis on Doppler Myocardial Performance Index in Patients with End-stage Renal Disease and Normal Left Ventricular Function

BACKGROUND: Doppler myocardial performance index (DMPI), defined as the sum of isovolumetric contraction time (IVCT) and isovolumetric relaxation time (IVRT) divided by ejection time (ET), is an easily measurable index which has been shown to reflect the severity of the disease. It has been known each component of DMPI, as IVCT, IVRT and ET, was affected by the change of preload. Therefore, the objective of this study was to estimate the changes of DMPI during intravascular volume reduction in patients with end-stage renal disease and to determine which components of DMPI contribute to DMPI alteration during intravacular volume reduction. METHODS: We measured blood pressure, heart rate, M-mode echocardiographic and Doppler parameters within 10 minutes before and after hemodialysis and ultrafitration with amount of average 2 L. RESULTS: We studied 40 end-stage renal disease patients (22 men and 18 women, mean age of 52 years) who had left ventricular hypertrophy 39 (97.5%) and normal left ventricular systolic function (diastolic interventricular septal thickness, 13.8+/-2 mm; diastolic left ventricular posterior wall thickness, 12.6+/-2 mm; Ejection fraction, 63.1+/-0.1%). Peak E-wave velocity was significantly decreased after hemodialysis and ultrafiltration (84.85+/-25 cm/s vs 72.89+/-23 cm/s, p<0.05), but other Doppler parameters such as peak A-wave velocity and E deceleration time were not changed. E/A ratio showed decreased tendency which was not significant statistically (p<0.097). DMPI was significantly increased after hemodialysis and ultrafiltration (0.41+/-0.14 vs 0.45+/-0.15, p<0.001). The increase of DMPI was mainly affected by prolongation of IVRT/ET which was due to prolonged IVRT, but IVCT/ET was not changed. The changes of DMPI was little with hemodialysis and ultrafiltration of about 2 L. CONCLUSION: We could prove that DMPI was preload dependent parameter of myocardial function. We suggest the change of preload should be considered as an important factor which may alter the DMPI.

A Case of Pure Unroofed Coronary Sinus without Persistent Left Superior Vena Cava

We report a case of 51-year-old woman with pure unroofed coronary sinus without persistent left superior vena cava and other cardiac anomaly. She presented with dyspnea on exertion during several years. Her chest film showed prominent cardiomegaly and dilated hilar vessels. Cardiac rhythm was atrial fibrillation. Transthoracic echocardiography demonstrated the enlarged coronary sinus with defect toward left atrium on parasternal long axis view and significant flow from coronary sinus into right atrium on subxyphoid view, and its other findings were dilated right ventricle and right atrium, paradoxical septal motion, moderate tricuspid regurgitation and mild mitral regurgitation, which were mimicking of large secundum atrial septal defect. Radionuclide cardioangiography and cardiac catheterization showed the existence of significant shunt. There was no evidence of persistent left superior vena cava on chest CT. Closure of Coronary sinus opening was done. Thereafter her symptoms of congestive heart failure were much improved. We think that careful examination of 2-D echocardiography can be valuable tool for diagnosis of unroofed coronary sinus in adult patient.