| 1. |
- Bjällmark, Anna, et al.
(författare)
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Effects of hemodialysis on the cardiovascular system: Quantitative analysis using wave intensity wall analysis and tissue velocity imaging
- 2010
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Ingår i: Heart and Vessels. - : Springer Science and Business Media LLC. - 0910-8327 .- 1615-2573.
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Tidskriftsartikel (refereegranskat)abstract
- Cardiovascular disease is the leading cause of death in patients with end stage renal disease (ESRD). The aim of this study was to investigate the changes in cardiovascular function induced by a single session of hemodialysis (HD) by the analysis of cardiovascular dynamics using wave intensity wall analysis (WIWA) and of systolic and diastolic myocardial function using tissue velocity imaging (TVI). Grey-scale cine loops of the left common carotid artery, conventional echocardiography and TVI images of the left ventricle were acquired before and after HD in 45 patients (17 women, mean age 54) with ESRD. The WIWA indexes, W1 preload-adjusted W1, W2 and preload-adjusted W2, and the TVI variables, isovolumic contraction velocity (IVCV), isovolumic contraction time (IVCT), peak systolic velocity (PSV), displacement, isovolumic relaxation velocity (IVRV), isovolumic relaxation time (IVRT), peak early diastolic velocity (E’) and peak late diastolic velocity (A’), were compared before and after HD. The WIWA measurements showed significant increases in W1 (p < 0.05) and preload-adjusted W1 (p < 0.01) after HD. W2 was significantly decreased (p < 0.05) after HD, whereas the change in preload-adjusted W2 was not significant. Systolic velocities, IVCV (p < 0.001) and PSV (p < 0.01), were increased after HD, whereas the AV-plane displacement were decreased (p < 0.01). For the measured diastolic variables, E’ was significantly decreased (p < 0.01) and IVRT was significantly prolonged (p < 0.05), after HD. A few correlations were found between WIWA and TVI variables. The WIWA and TVI measurements indicate that a single session of HD improves systolic function. The load dependency of the diastolic variables seems to be more pronounced than for the systolic variables. Preload-adjusted wave intensity indexes may contribute in the assessment of true LV contractility and relaxation.
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| 2. |
- Hayashi, Shirley Yumi, et al.
(författare)
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A single session of haemodialysis improves left ventricular synchronicity in patients with end-stage renal disease : A pilot tissue synchronization imaging study
- 2008
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Ingår i: Nephrology, Dialysis and Transplantation. - : Oxford University Press (OUP). - 0931-0509 .- 1460-2385. ; 23:11, s. 3622-3628
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Tidskriftsartikel (refereegranskat)abstract
- Background. Mechanical left ventricular (LV) dyssynchrony impairs cardiac function in patients with heart failure and LV hypertrophy (LVH) and may be a factor contributing to the high incidence of cardiac deaths in patients with end-stage renal disease (ESRD). Objectives. To evaluate the possible presence of LV dyssynchrony in ESRD patients, and acute effect of haemodialysis (HD) on LV synchronicity using a tailored echocardiographic modality, tissue synchronization imaging (TSI). Methods. In 13 clinically stable ESRD patients (7 men; 65 +/- 10 years) with LVH, echocardiography data were acquired before and after a single HD session for subsequent off-line TSI analysis enabling the retrieval of regional intraventricular systolic delay data. Six basal and six midventricular LV segments were evaluated. Dyssynchrony was defined as a regional difference in time to peak systolic velocity > 105 ms. Results. Before HD, all patients had at least one dyssynchronous LV segment. The percentage of delayed segments correlated positively to LV end-diastolic diameter (r = 0.68, P < 0.05). HD induced a substantial decrease in the percentage of delayed segments from 36 +/- 25% to 19 +/- 14% (P < 0.01), reduced average maximal mechanical systolic LV delay from 300 +/- 89 to 225 +/- 116 ms (P < 0.05) and completely normalized LV synchronicity in three patients (23%). Conclusions. LV dyssynchrony appears to be present frequently in ESRD patients with LVH. The severity of LV dyssynchrony correlates with LV end-diastolic diameter and decreases after a single session of HD suggesting a mechanistic relevance of volume overload and possibly other toxins accumulating in HD patients.
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| 3. |
- Hayashi, Shirley Yumi, et al.
(författare)
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Acute effects of low and high intravenous doses of furosemide on myocardial function in anuric haemodialysis patients : a tissue Doppler study
- 2008
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Ingår i: Nephrology, Dialysis and Transplantation. - : Oxford University Press (OUP). - 0931-0509 .- 1460-2385. ; 23:4, s. 1355-1361
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Tidskriftsartikel (refereegranskat)abstract
- Background. In patients with pulmonary oedema and preserved renal function, furosemide has not only a renal, but also a vascular effect, causing a rapid fall in left ventricular filling pressure accompanied by an increase in venous compliance. Previous studies have shown conflicting findings regarding the vascular effects of furosemide in patients with end-stage renal disease (ESRD). The objective of our study was to investigate whether furosemide induces changes in central cardiac haemodynamics in anuric ESRD patients, using conventional echocardiography and colour tissue Doppler velocity imaging (TVI), a new quantitative and sensitive method. Methods. Repeated low doses (40 mg followed by an additional dose of 40 mg after 30 min) of i.v. furosemide were administered to 12 (61.6 +/- 16 years, 7 men) and a high dose (250 mg) of i.v. furosemide to 6 (64.1 +/- 3.6 years, 5 men) clinically stable anuric haemodialysis (HD) patients. Conventional two-dimensional echocardiography and colour TVI images were recorded immediately before (0 min) the furosemide infusion in both groups, and in the group receiving the repeated low-dose infusion (at 0 and 30 min), 10, 20, 30, 40, 50 and 70 min after the administration of the first infusion. In the group receiving the single high dose of furosemide the ultrasound investigation was repeated 10, 20, 30 and 40 min after the infusion. The myocardial tissue velocities (v; cm/s) for isovolumetric contraction (IVC), peak systole (PS), early (E') and late (A') myocardial diastolic filling velocities were measured in the left ventricle (LV) at six sites (infero-septal, antero-lateral, inferior, anterior, infero-lateral and antero-septal walls) at the basal region. IVC time (IVCT), IV relaxation time (IVRT), PS time (PSt), RR interval, mitral annulus motion (MAM), strain rate (SR), left ventricular filling pressure (E/E') and cardiac output were also measured. The average of the different walls was used to evaluate global function. Right ventricle (RV) dynamics was evaluated from measurements of IVC velocity (IVCv), peak systolic velocity (PSv), E' and A' from the RV free wall. Results. No significant changes in cardiac output, IVCv, PSv, SR, MAM, E', A', E'/A', IVRT and LV filling pressure were observed, indicating that neither 40 mg (plus additional 40 mg after 30 min) nor 250 mg of furosemide had any measurable effects on LV filling pressure and LV and RV systolic and diastolic function. Conclusions. In anuric HD patients, low and high doses of furosemide had no significant effects on central cardiac haemodynamics. Therefore, the use of furosemide infusion in anuric ESRD patients with acute pulmonary oedema is not supported by the results of this study.
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| 4. |
- Hayashi, Shirley Yumi, et al.
(författare)
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Analysis of mitral annulus motion measurements derived from M-mode, anatomic M-mode, tissue Doppler displacement, and 2-dimensional strain imaging
- 2006
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Ingår i: Journal of the American Society of Echocardiography. - : Elsevier BV. - 0894-7317 .- 1097-6795. ; 19:9, s. 1092-1101
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Tidskriftsartikel (refereegranskat)abstract
- Background: Left ventricular longitudinal shortening plays an important role in cardiac contraction and can be measured by the mitral annulus motion (MAM) toward the cardiac apex. MAM can be evaluated by conventional M-mode, anatomic M-mode (AM-mode), tissue Doppler displacement (TDD), and 2-dimensional strain imaging (2DSI). Objective: The aim of the study was to compare these 4 different methods for measuring MAM. Methods: MAM was evaluated in 25 patients by M-mode, AM-mode, TDD, and 2DSI. Two walls (septal and lateral) in apical 4-chamber view were analyzed. Results. The angle correction between M-mode and AM-mode was significantly higher in the lateral wall (septum 2.2+/-1.6 vs lateral 4.1+/-1.6 degrees, P<0.01). However, with angle correction up to 8 degrees, the measurements obtained were not significantly different from those obtained by M-mode. No significant differences were found among 2DSI. M-mode, and AM-mode either, although all of them were significantly higher in comparison with TDD measurements in both septal (M-mode [11.0 +/- 2.4 nun], AM-mode [11.8 +/- 2.4 mm], 2DSI [11.0 +/- 3.4 mm] vs TDD [9.2 +/- 3.3 mm], P<.01) and lateral (M-mode [11.9 +/- 2.3 min], AM-mode [12.4 +/- 2.8 mm], 2DSI [10.4 +/- 3.9 mm] vs TDD [8.9 +/- 3.0 mm], P<.05) walls. The +/- 2SD variation from the mean difference in septal and lateral walls were, respectively, between: M-mode and TDD, -2.4 to 5.9 and -2.2 to 8.2 mm; M-mode and 2DSI, -5.7 to 5.7 and -5.8 to 8.7; AM-mode and TDD, -2.5 to 5.6 and -2.7 to 9.6; AM-mode and 2DSI, -5.7 to 5.87 and -5.9 to 9.8 and TDD and 2DSI, -3.2 to 6.6 and -5.3 to 8.4. Conclusions: AM-mode and M-mode measurements did not differ significantly. Despite the good correlation among all methods they were not interchangeable. TDD measurements were significantly lower than M-mode, AM-mode, and 2DSI measurements. M-mode and AM-mode are angle dependent and can, therefore, underestimate or overestimate MAM. The new method of 2DSI is promising because it tracks natural acoustic markers and is not angle dependent and, therefore, measures the true local tissue motion.
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| 5. |
- Hayashi, Shirley Yumi, et al.
(författare)
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Improvement of cardiac function after haemodialysis : Quantitative evaluation by colour tissue velocity imaging
- 2004
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Ingår i: Nephrology, Dialysis and Transplantation. - : Oxford University Press (OUP). - 0931-0509 .- 1460-2385. ; 19:6, s. 1497-1506
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Tidskriftsartikel (refereegranskat)abstract
- Background. Overhydration and accumulation of uraemic toxins may influence the myocardial function in haemodialysis (HD) patients. To evaluate cardiac function and the effects of fluid and solute removal during a single session of HD, colour tissue velocity imaging (TVI) was used. This new technique, which is less load dependent than conventional echocardiography, allows an objective quantitative assessment of myocardial contractility, contraction and relaxation. Methods. Conventional echocardiographic and TVI images were recorded before and after a single HD session in 13 clinically stable HD patients (62 +/- 10 years, six males) and in 13 sex- and age-matched healthy controls. Myocardial tissue velocities (v; cm/s) for isovolumetric contraction (IVC), peak systole (PS), early (E) and late (A') diastolic filling and strain rate (SR) were measured. Results. Left ventricular hypertrophy (LVH) was present in 12 patients. TVI gave additional information in comparison with conventional echocardiography. Before HD, PS (5.0 +/- 0.8 vs 6.0 +/- 1.2 cm/s, P < 0.05), E' (5.7 +/- 1.7 vs 7.3 +/- 2.0 cm/s, P < 0.05) and A' (6.6 +/- 1.7 vs. 8.3 +/- 2.9 cm/s, P < 0.05) velocities were lower in the patients than in the controls, indicating systolic and diastolic dysfunction. The HD session increased IVCv (4.0 +/- 1.7 to 5.5 +/- 1.9 cm/s; P < 0.001), PSv (5.0 +/- 0.8 to 5.7 +/- 0.8 cm/s; P < 0.05) and SR (0.7 +/- 0.2 to 0.9 +/- 0.2 1/s; P < 0.05) and decreased E/E' (16.7 +/- 7.7 to 12.2 +/- 4.0, P < 0.05), indicating improved systolic function and decreased LV filling pressure, respectively. Linear regression analysis demonstrated a dependency of systolic contraction (PSv) and contractility (IVCv) upon plasma levels of phosphate (r(2) = 0.70, P < 0.005, r(2) = 0.33, P < 0.01). Conclusions. Using TVI, HD patients demonstrate myocardial dysfunction, which is found less frequently when using conventional echocardiography. The systolic function seems to be impaired by high plasma levels of phosphate and an increased Ca x P product. One single session of HD improved systolic function as indicated by increases in IVCv, PSv and SR. Further studies are needed to clarify if this effect of HD is due to the acute removal of fluid, the removal of solutes or both.
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| 6. |
- Hayashi, Shirley Yumi, et al.
(författare)
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Left ventricular function in patients with chronic kidney disease evaluated by colour tissue Doppler velocity imaging
- 2006
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Ingår i: Nephrology, Dialysis and Transplantation. - : Oxford University Press (OUP). - 0931-0509 .- 1460-2385. ; 21:1, s. 125-132
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Tidskriftsartikel (refereegranskat)abstract
- Background. Cardiovascular disease is the leading cause of death in chronic kidney disease (CKD) patients. Tissue Doppler velocity imaging (TVI) is a new objective method that accurately quantifies myocardial tissue velocities, deformation, time intervals and left ventricular (LV) filling pressure. In this study, TVI was compared with conventional echocardiography for the assessment of left ventricular (LV) function in pre-dialysis patients with different stages of CKD. The results obtained by TVI were used to analyse possible relationships between LV function and clinical factors such as hyperparathyroidism and hypertension that could influence LV function. Methods. Conventional echocardiography and TVI images were recorded in 40 patients (36 men and 4 women, mean age 60 +/- 14 years, range 28-80 years) and in 27 healthy controls (21 men and 6 women, mean age 58 +/- 17 years, range 28-82 years). Twenty-two patients had mild/moderate CKD (CCr > 29 ml/min; Group 1) and 18 patients had severe CKD (CCr <= 29 ml/min; Group 2). Using TVI, the myocardial tissue velocities (v; cm/s) for isovolumetric contraction (IVCv), peak systole (PSv), early (E') and late (A') diastolic filling velocities as well as strain rate (SR), mitral annulus displacement, isovolumetric relaxation time (IVRT) and LV filling pressure were estimated using TVI. The average of six LV wall measurements was used to evaluate LV global function. Results. Using TVI, we were able to identify significantly more patients with diastolic dysfunction than using conventional echocardiography (33 vs 26, P < 0.05). There was no difference in the prevalence of diastolic dysfunction between Group 1 and 2. However, using TVI, Group 2 CKD patients had lower E' velocities (6.2 +/- 1.9 vs 8.0 +/- 2.9 cm/s, P < 0.05) and higher IVRT (137.4 +/- 13 vs 88.2 +/- 26 ms, P < 0.001) in comparison with controls, indicating more accentuated diastolic dysfunction. Systolic blood pressure (SBP) was associated with E' velocities (rho = -0.68, P < 0.005) and E'/A' was strongly associated with SBP (rho = -0.60; P < 0.01) and PTH (rho = -0.64, P < 0.005) in Group 2. Using conventional echocardiography, there was no difference in the prevalence of systolic and diastolic dysfunction between patients with and without LVH. However, using TVI, patients with LVH had significantly lower IVCv (2.8 +/- 1.3 vs 3.8 +/- 1.5 and 3.8 +/- 1.5 cm/s, P < 0.05) and PSv (5.5 +/- 1.0 vs 6.3 +/- 1.2 and 6.4 +/- 1.3 cm/s, P < 0.05) compared with patients without LVH and controls, and they also had lower E' velocities (7.1 +/- 2.7 vs 8.0 +/- 2.9 cm/s, P < 0.05) compared with controls, indicating disturbances in systolic and diastolic left ventricular function. Conclusions. TVI provided additional information on left ventricular function in CKD patients. In patients with advanced renal failure, TVI revealed more accentuated diastolic dysfunction associated with increased systolic blood pressure (SBP) and increased levels of PTH. TVI also demonstrated disturbances in contractility and contraction in patients with LVH, which could not be detected by conventional echocardiography.
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| 7. |
- Hayashi, Shirley Yumi, et al.
(författare)
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Left ventricular mechanical dyssynchrony in patients with different stages of chronic kidney disease and the effects of hemodialysis
- 2013
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Ingår i: Hemodialysis International. - : Wiley-Blackwell. - 1492-7535 .- 1542-4758. ; 17:3, s. 346-358
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Tidskriftsartikel (refereegranskat)abstract
- Left ventricular (LV) dyssynchrony is a known cause of mortality in patients with heart failure and may possibly play a similar role in patients with chronic kidney disease (CKD) in whom sudden death is one of the most common and as yet not fully explained cause of death. LV synchronicity and its relationship with increased volume load and various biomarkers was analyzed in 145 patients including 53 patients with CKD stages 3 and 4 and in 92 CKD stage 5 patients undergoing hemodialysis (HD) or peritoneal dialysis (PD) using color tissue Doppler imaging and tissue synchronization imaging. The HD patients were evaluated both before and after a single HD session. LV dyssynchrony was defined as a regional difference in time to peak systolic myocardial velocity, between 12 LV segments>105milliseconds. LV dyssynchrony was present in 54% of the patients with no difference between CKD 3 and 4 (58%), HD (48%), and PD (51%). LV dyssynchrony was independently associated with LV mass index and increased estimation of LV end-diastolic pressure. A single HD session resulted in significant changes in LV synchronicity variableswith improvement in 50% of the patientsespecially in patients with higher myocardial systolic velocities and lower LV mass index. Abnormalities in LV synchronicity are highly prevalent in CKD patients already prior to dialysis treatment and are associated with LV hypertrophy, LV dysfunction and load conditions, underlining the importance of volume status for LV synchronicity in CKD patients.
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