Left ventricular diastolic dysfunctions in chronic renal failure patients on healmoodilysis

ABSTRACT

Left ventricular structure and function abnormalities are frequent in individuals with chronic uremia. This disorders are frequent in patients who has increased risk of cardiovascular diseases. The aim of this study is to study the leading alteration in left ventricular diastolic function and factors related to it, using simple indices of diastolic function obtained with pulsed Doppler studies. This study was conducted on -40 patients who had end stage renal disease. They were on regular maintenance haemodialysis 3 times / week compared to 29 age and sex matched healthy subject, served as control group. All of them were subjected to the following- full history and clinical examination including age, sex, duration of dialysis, causes of renal failure laboratory investigations were done and include renal functions [urea, creatinine], full blood, picture blood, sugar, serum inorganic phosphorous, parathyroid hormone [PTH], alkaline phosphatase, serum albumin and total protein. Echo cardiography for assessment of left ventricular end diastolic dimension [LVEDD], left ventricular end systolic dimension [LVESD], posterior wall thickness in diastole [PWT], inter ventricular wall thickness in diastole [IVS], fraction shortening [FS%], ejection fraction [EF%]. Echo doppler examination including peak flow velocity in early diastole [E-wave], peak flow velocity in late systole [A-wave] E/A ratio, acceleration time [AT], deceleration time [D.T], and isovolumic relaxation time. Result showed that there were a significant increase in left atrial diameter [P<0.01], left ventricular posterior wall thickness, [p <0.01] interventricular septum thickness, [p<0.001] left ventricular mass [p<0.001] in ESRD patients when compared with control group. There were highly significant increase in A-wave [p<0.01] deceleration time [p<0.05] and isovolumic relaxation time [p<0.01] while there were no significant difference in aortic root diameter, left ventricular end systolic dimension, E wave, fractional shortening and ejection fraction, in patients compared with control group. There were significant positive correlation between left atrial diameter and systolic blood pressure, positive correlation between left ventricular mass and both systolic and diastolic blood pressure, positive correlation between parathyroid hormone level and E-wave, negative correlation between left vetricular end diastolic dimension and hemoglobin concentration, negative correlation between left ventricular posterior wall thickness and hemoglobin concentration and negative correlation between parathyroid hormone level and ejection fraction. Cardio vascular complications are frequent in patients with ESRD. Echo cardiography and echo doppler cardiography are recommended in all patients with ESRD