TY - JOUR
T1 - Effect of isolated ultrafiltration and isovolemic dialysis on myocardial perfusion and left ventricular function assessed with 13 N-NH 3 positron emission tomography and echocardiography
AU - Assa, Solmaz
AU - Kuipers, Johanna
AU - Ettema, Esmée
AU - Gaillard, Carlo A.J.M.
AU - Krijnen, Wim P.
AU - Hummel, Yoran M.
AU - Voors, Adriaan A.
AU - Van Melle, Joost P.
AU - Westerhuis, Ralf
AU - Willemsen, Antoon
AU - Slart, Riemer H.J.A.
AU - Franssen, Casper F.M.
N1 - Funding Information:
This study was supported by an unrestricted grant from Amgen BV.
Publisher Copyright:
© 2018 American Physiological Society. All rights reserved.
PY - 2018/3
Y1 - 2018/3
N2 - Hemodialysis is associated with a fall in myocardial perfusion and may induce regional left ventricular (LV) systolic dysfunction. The pathophysiology of this entity is incompletely understood, and the contribution of ultrafiltration and diffusive dialysis has not been studied. We investigated the effect of isolated ultrafiltration and isovolemic dialysis on myocardial perfusion and LV function. Eight patients (7 male, aged 55 = 18 yr) underwent 60 min of isolated ultrafiltration and 60 min of isovolemic dialysis in randomized order. Myocardial perfusion was assessed by 13 N-NH 3 positron emission tomography before and at the end of treatment. LV systolic function was assessed by echocardiography. Regional LV systolic dysfunction was defined as an increase in wall motion score in ≥2 segments. Isolated ultrafiltration (ultrafiltration rate 13.6 = 3.9 ml·kg +1 ·h +1 ) induced hypovolemia, whereas isovolemic dialysis did not (blood volume change ±6.4 = 2.2 vs. ±1.3 = 3.6%). Courses of blood pressure, heart rate, and tympanic temperature were comparable for both treatments. Global and regional myocardial perfusion did not change significantly during either isolated ultrafiltration or isovolemic dialysis and did not differ between treatments. LV ejection fraction and the wall motion score index did not change significantly during either treatment. Regional LV systolic dysfunction developed in one patient during isolated ultrafiltration and in three patients during isovolemic dialysis. In conclusion, global and regional myocardial perfusion was not compromised by 60 min of isolated ultrafiltration or isovolemic dialysis. Regional LV systolic dysfunction developed during isolated ultrafiltration and isovolemic dialysis, suggesting that, besides hypovolemia, dialysis-associated factors may be involved in the pathogenesis of hemodialysis-induced regional LV dysfunction.
AB - Hemodialysis is associated with a fall in myocardial perfusion and may induce regional left ventricular (LV) systolic dysfunction. The pathophysiology of this entity is incompletely understood, and the contribution of ultrafiltration and diffusive dialysis has not been studied. We investigated the effect of isolated ultrafiltration and isovolemic dialysis on myocardial perfusion and LV function. Eight patients (7 male, aged 55 = 18 yr) underwent 60 min of isolated ultrafiltration and 60 min of isovolemic dialysis in randomized order. Myocardial perfusion was assessed by 13 N-NH 3 positron emission tomography before and at the end of treatment. LV systolic function was assessed by echocardiography. Regional LV systolic dysfunction was defined as an increase in wall motion score in ≥2 segments. Isolated ultrafiltration (ultrafiltration rate 13.6 = 3.9 ml·kg +1 ·h +1 ) induced hypovolemia, whereas isovolemic dialysis did not (blood volume change ±6.4 = 2.2 vs. ±1.3 = 3.6%). Courses of blood pressure, heart rate, and tympanic temperature were comparable for both treatments. Global and regional myocardial perfusion did not change significantly during either isolated ultrafiltration or isovolemic dialysis and did not differ between treatments. LV ejection fraction and the wall motion score index did not change significantly during either treatment. Regional LV systolic dysfunction developed in one patient during isolated ultrafiltration and in three patients during isovolemic dialysis. In conclusion, global and regional myocardial perfusion was not compromised by 60 min of isolated ultrafiltration or isovolemic dialysis. Regional LV systolic dysfunction developed during isolated ultrafiltration and isovolemic dialysis, suggesting that, besides hypovolemia, dialysis-associated factors may be involved in the pathogenesis of hemodialysis-induced regional LV dysfunction.
KW - Cardiac stunning
KW - Hemodialysis
KW - Myocardial perfusion
KW - Ultrafiltration
UR - http://www.scopus.com/inward/record.url?scp=85043602572&partnerID=8YFLogxK
U2 - 10.1152/ajprenal.00368.2017
DO - 10.1152/ajprenal.00368.2017
M3 - Article
C2 - 29117996
AN - SCOPUS:85043602572
SN - 1931-857X
VL - 314
SP - F445-F452
JO - American Journal of Physiology - Renal Physiology
JF - American Journal of Physiology - Renal Physiology
IS - 3
ER -
