Real-time three-dimensional echocardiography provides advanced haemodynamic information associated with intra-dialytic hypotension in patients with autonomic dysfunction

Ning I. Yang, Chao Hung Wang, Ming Jui Hung, Yung Chih Chen, I. Wen Wu, Chin Chan Lee, Mai Szu Wu, Li Tang Kuo, Chi Wen Cheng, Wen Jin Cherng

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background. Real-time three-dimensional echocardiography (RT3DE) has emerged as a more accurate and effective tool for assessing left ventricular (LV) function, compared to traditional two-dimensional (2D) methods. In this study, we used this new tool to revise the controversial relationship between LV function and intra-dialytic hypotension.Methods. This study enrolled 29 intra-dialytic hypotensive patients (the IDH group) and 34 controls (the CON group) on regular maintenance haemodialysis. The RT3DE- and 2D-derived ejection fraction (EF), stroke volume index (SVI) and ratio of early transmitral inflow velocity to diastolic early tissue velocity were assessed at pre-dialysis and mid-dialysis. The intravascular volume was assessed by the inferior vena cava collapsibility index.Results. Pre-dialysis evaluation showed no difference in RT3DE- and 2D-derived parameters between the two groups. At mid-dialysis, the IDH group had a lower 2D EF (54 ± 9.1 versus 62 ± 6.8 in the CON group, P <0.001), RT3DE EF (53 ± 6 versus 60 ± 7 in the CON group, P <0.001) and SVI (24.3 ± 8 versus 30.6 ± 12.2 mL in the CON group, P = 0.02). From pre-dialysis to mid-dialysis, the IDH group had greater decrease in the change in 2D EF (-4.8 ± 12.6 versus 5 ± 13.7 in the CON group, P = 0.004), RT3DE EF (-11.8 ± 10.3 versus -3.4 ± 11.5 in the CON group, P = 0.003) and SVI (-17.3 ± 18.5 versus -9.2 ± 19.8 in the CON group, P = 0.004). The calculated cardiac index change also showed a greater decrease in the IDH group (-17.8 ± 20.2 versus -5.7 ± 18.5 in the CON group, P = 0.02). No significant difference in the ratio of early transmitral inflow velocity to diastolic early tissue velocity, heart rate, systemic vascular resistance index or inferior vena cava collapsibility index was found between the two groups at the baseline or mid-dialysis. A lack of an increase in heart rate and the systemic vascular resistance index in the IDH group during the hypotensive episodes implies that these patients have autonomic dysfunction. Multivariate analysis showed that the RT3DE EF change of <-9.5 (odds ratio = 6, P = 0.003) and the presence of diabetes (odds ratio = 4.4, P = 0.013) had significant and independent associations with intra-dialytic hypotension.Conclusions. By adopting RT3DE to assess LV performance, our data demonstrated that an inadequate compensation in the LV systolic function is the main mechanism mediating the occurrence of intra-dialytic hypotension in patients with autonomic dysfunction.

Original languageEnglish
Pages (from-to)249-254
Number of pages6
JournalNephrology Dialysis Transplantation
Volume25
Issue number1
DOIs
Publication statusPublished - Jan 2010
Externally publishedYes

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Three-Dimensional Echocardiography
Hypotension
Dialysis
Hemodynamics
Left Ventricular Function
Stroke Volume
Inferior Vena Cava
Vascular Resistance
Heart Rate
Odds Ratio
Renal Dialysis
Multivariate Analysis
Maintenance
Control Groups

Keywords

  • Intra-dialytic hypotension
  • Left ventricular dysfunction
  • Three-dimensional echocardiography

ASJC Scopus subject areas

  • Nephrology
  • Transplantation

Cite this

Real-time three-dimensional echocardiography provides advanced haemodynamic information associated with intra-dialytic hypotension in patients with autonomic dysfunction. / Yang, Ning I.; Wang, Chao Hung; Hung, Ming Jui; Chen, Yung Chih; Wu, I. Wen; Lee, Chin Chan; Wu, Mai Szu; Kuo, Li Tang; Cheng, Chi Wen; Cherng, Wen Jin.

In: Nephrology Dialysis Transplantation, Vol. 25, No. 1, 01.2010, p. 249-254.

Research output: Contribution to journalArticle

Yang, Ning I. ; Wang, Chao Hung ; Hung, Ming Jui ; Chen, Yung Chih ; Wu, I. Wen ; Lee, Chin Chan ; Wu, Mai Szu ; Kuo, Li Tang ; Cheng, Chi Wen ; Cherng, Wen Jin. / Real-time three-dimensional echocardiography provides advanced haemodynamic information associated with intra-dialytic hypotension in patients with autonomic dysfunction. In: Nephrology Dialysis Transplantation. 2010 ; Vol. 25, No. 1. pp. 249-254.
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abstract = "Background. Real-time three-dimensional echocardiography (RT3DE) has emerged as a more accurate and effective tool for assessing left ventricular (LV) function, compared to traditional two-dimensional (2D) methods. In this study, we used this new tool to revise the controversial relationship between LV function and intra-dialytic hypotension.Methods. This study enrolled 29 intra-dialytic hypotensive patients (the IDH group) and 34 controls (the CON group) on regular maintenance haemodialysis. The RT3DE- and 2D-derived ejection fraction (EF), stroke volume index (SVI) and ratio of early transmitral inflow velocity to diastolic early tissue velocity were assessed at pre-dialysis and mid-dialysis. The intravascular volume was assessed by the inferior vena cava collapsibility index.Results. Pre-dialysis evaluation showed no difference in RT3DE- and 2D-derived parameters between the two groups. At mid-dialysis, the IDH group had a lower 2D EF (54 ± 9.1 versus 62 ± 6.8 in the CON group, P <0.001), RT3DE EF (53 ± 6 versus 60 ± 7 in the CON group, P <0.001) and SVI (24.3 ± 8 versus 30.6 ± 12.2 mL in the CON group, P = 0.02). From pre-dialysis to mid-dialysis, the IDH group had greater decrease in the change in 2D EF (-4.8 ± 12.6 versus 5 ± 13.7 in the CON group, P = 0.004), RT3DE EF (-11.8 ± 10.3 versus -3.4 ± 11.5 in the CON group, P = 0.003) and SVI (-17.3 ± 18.5 versus -9.2 ± 19.8 in the CON group, P = 0.004). The calculated cardiac index change also showed a greater decrease in the IDH group (-17.8 ± 20.2 versus -5.7 ± 18.5 in the CON group, P = 0.02). No significant difference in the ratio of early transmitral inflow velocity to diastolic early tissue velocity, heart rate, systemic vascular resistance index or inferior vena cava collapsibility index was found between the two groups at the baseline or mid-dialysis. A lack of an increase in heart rate and the systemic vascular resistance index in the IDH group during the hypotensive episodes implies that these patients have autonomic dysfunction. Multivariate analysis showed that the RT3DE EF change of <-9.5 (odds ratio = 6, P = 0.003) and the presence of diabetes (odds ratio = 4.4, P = 0.013) had significant and independent associations with intra-dialytic hypotension.Conclusions. By adopting RT3DE to assess LV performance, our data demonstrated that an inadequate compensation in the LV systolic function is the main mechanism mediating the occurrence of intra-dialytic hypotension in patients with autonomic dysfunction.",
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author = "Yang, {Ning I.} and Wang, {Chao Hung} and Hung, {Ming Jui} and Chen, {Yung Chih} and Wu, {I. Wen} and Lee, {Chin Chan} and Wu, {Mai Szu} and Kuo, {Li Tang} and Cheng, {Chi Wen} and Cherng, {Wen Jin}",
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TY - JOUR

T1 - Real-time three-dimensional echocardiography provides advanced haemodynamic information associated with intra-dialytic hypotension in patients with autonomic dysfunction

AU - Yang, Ning I.

AU - Wang, Chao Hung

AU - Hung, Ming Jui

AU - Chen, Yung Chih

AU - Wu, I. Wen

AU - Lee, Chin Chan

AU - Wu, Mai Szu

AU - Kuo, Li Tang

AU - Cheng, Chi Wen

AU - Cherng, Wen Jin

PY - 2010/1

Y1 - 2010/1

N2 - Background. Real-time three-dimensional echocardiography (RT3DE) has emerged as a more accurate and effective tool for assessing left ventricular (LV) function, compared to traditional two-dimensional (2D) methods. In this study, we used this new tool to revise the controversial relationship between LV function and intra-dialytic hypotension.Methods. This study enrolled 29 intra-dialytic hypotensive patients (the IDH group) and 34 controls (the CON group) on regular maintenance haemodialysis. The RT3DE- and 2D-derived ejection fraction (EF), stroke volume index (SVI) and ratio of early transmitral inflow velocity to diastolic early tissue velocity were assessed at pre-dialysis and mid-dialysis. The intravascular volume was assessed by the inferior vena cava collapsibility index.Results. Pre-dialysis evaluation showed no difference in RT3DE- and 2D-derived parameters between the two groups. At mid-dialysis, the IDH group had a lower 2D EF (54 ± 9.1 versus 62 ± 6.8 in the CON group, P <0.001), RT3DE EF (53 ± 6 versus 60 ± 7 in the CON group, P <0.001) and SVI (24.3 ± 8 versus 30.6 ± 12.2 mL in the CON group, P = 0.02). From pre-dialysis to mid-dialysis, the IDH group had greater decrease in the change in 2D EF (-4.8 ± 12.6 versus 5 ± 13.7 in the CON group, P = 0.004), RT3DE EF (-11.8 ± 10.3 versus -3.4 ± 11.5 in the CON group, P = 0.003) and SVI (-17.3 ± 18.5 versus -9.2 ± 19.8 in the CON group, P = 0.004). The calculated cardiac index change also showed a greater decrease in the IDH group (-17.8 ± 20.2 versus -5.7 ± 18.5 in the CON group, P = 0.02). No significant difference in the ratio of early transmitral inflow velocity to diastolic early tissue velocity, heart rate, systemic vascular resistance index or inferior vena cava collapsibility index was found between the two groups at the baseline or mid-dialysis. A lack of an increase in heart rate and the systemic vascular resistance index in the IDH group during the hypotensive episodes implies that these patients have autonomic dysfunction. Multivariate analysis showed that the RT3DE EF change of <-9.5 (odds ratio = 6, P = 0.003) and the presence of diabetes (odds ratio = 4.4, P = 0.013) had significant and independent associations with intra-dialytic hypotension.Conclusions. By adopting RT3DE to assess LV performance, our data demonstrated that an inadequate compensation in the LV systolic function is the main mechanism mediating the occurrence of intra-dialytic hypotension in patients with autonomic dysfunction.

AB - Background. Real-time three-dimensional echocardiography (RT3DE) has emerged as a more accurate and effective tool for assessing left ventricular (LV) function, compared to traditional two-dimensional (2D) methods. In this study, we used this new tool to revise the controversial relationship between LV function and intra-dialytic hypotension.Methods. This study enrolled 29 intra-dialytic hypotensive patients (the IDH group) and 34 controls (the CON group) on regular maintenance haemodialysis. The RT3DE- and 2D-derived ejection fraction (EF), stroke volume index (SVI) and ratio of early transmitral inflow velocity to diastolic early tissue velocity were assessed at pre-dialysis and mid-dialysis. The intravascular volume was assessed by the inferior vena cava collapsibility index.Results. Pre-dialysis evaluation showed no difference in RT3DE- and 2D-derived parameters between the two groups. At mid-dialysis, the IDH group had a lower 2D EF (54 ± 9.1 versus 62 ± 6.8 in the CON group, P <0.001), RT3DE EF (53 ± 6 versus 60 ± 7 in the CON group, P <0.001) and SVI (24.3 ± 8 versus 30.6 ± 12.2 mL in the CON group, P = 0.02). From pre-dialysis to mid-dialysis, the IDH group had greater decrease in the change in 2D EF (-4.8 ± 12.6 versus 5 ± 13.7 in the CON group, P = 0.004), RT3DE EF (-11.8 ± 10.3 versus -3.4 ± 11.5 in the CON group, P = 0.003) and SVI (-17.3 ± 18.5 versus -9.2 ± 19.8 in the CON group, P = 0.004). The calculated cardiac index change also showed a greater decrease in the IDH group (-17.8 ± 20.2 versus -5.7 ± 18.5 in the CON group, P = 0.02). No significant difference in the ratio of early transmitral inflow velocity to diastolic early tissue velocity, heart rate, systemic vascular resistance index or inferior vena cava collapsibility index was found between the two groups at the baseline or mid-dialysis. A lack of an increase in heart rate and the systemic vascular resistance index in the IDH group during the hypotensive episodes implies that these patients have autonomic dysfunction. Multivariate analysis showed that the RT3DE EF change of <-9.5 (odds ratio = 6, P = 0.003) and the presence of diabetes (odds ratio = 4.4, P = 0.013) had significant and independent associations with intra-dialytic hypotension.Conclusions. By adopting RT3DE to assess LV performance, our data demonstrated that an inadequate compensation in the LV systolic function is the main mechanism mediating the occurrence of intra-dialytic hypotension in patients with autonomic dysfunction.

KW - Intra-dialytic hypotension

KW - Left ventricular dysfunction

KW - Three-dimensional echocardiography

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