Objective: Overhydratation and accumulation of uremic toxins may influence the myocardial function in hemodialysis (HD) patients. The aim of the present study was to examine the effect of volume removal by HD on conventional and tissue Doppler imaging (TDI) indices of systolic and diastolic function of the right and left ventricles.

Patients and methods: Seventeen patients (age 31 ± 10 years, 8 males) on maintenance HD (5 hours twice a week), free from clinically overt cardiac dysfunction, underwent echocardiography 30 min before and 30 min after HD: the aim of fluid removal was to achieve a clinically determined ‘dry weight’. A detailed 2D and Doppler examination was made to assess left ventricular (LV) structure and function including measurement of longitudinal mitral and tricuspid annular motion velocities by TDI. Myocardial systolic wave (s) and early (E’) and late (A’) diastolic waves were measured.

Results: HD results in a mean reduction in weight of 2.70 ± 1.04kg. Following HD, there were significant reduction in left ventricular end-diastolic and end-systolic volume, right ventricular end-diastolic diameter, and left atrium anteroposterior diameter (LVEDV, 85.2 ± 27.9 vs. 61.5 ± 24.8, p < 0.0001 ; LVESV, 37.4 ± 15.2 vs. 30.2 ± 13.6, p < 0.001 ; RVEDD, 24.03 ± 3.55, 21.31 ± 2.94, p < 0.001 ; LA, 37.96 ± 3.90 vs. 30.62 ± 3.38, p < 0.0001). Also consistent with a reduction in preload there was a reduction in the peak early transmitral flow velocity (E, 96, 54 ± 23.13 vs. 63.65 ± 16.33, p = 0.0001) and in the ratio of peak early filling velocity to peak late filling velocity (E/A, 1.14 ± 0.32 vs. 0.94 ± 0.25, p = 0.021). E’ velocities in lateral side of mitral annulus didn’t change significantly after HD whereas E’ in septal side decreased only in patient who had normal diastolic function (p = 0.002) and correlated in multivariate analysis with hematocrit (p = 0.027) and hemoglobin (p = 0.046). Late diastolic (A’) velocities in both sides of mitral annulus did not change after HD. The E- to- E’ ratio significantly decreased on the lateral (p = 0.003), but not on the septal side of the annulus. Systolic mitral annular velocities decreased after HD in both sides (septal, 6.90 ± 1.10 vs. 5.97 ± 1.48, p = 0.006 ; lateral 8.68 ± 2.67 vs. 6.94 ± 1.52, p = 0.011). This decrease did not correlate with fluid removal or changes of weight.

Systolic tricuspid annular velocities increased after HD (13.45 ± 1.47 vs. 17.3 ± 1.90, p = 0.002) and early diastolic velocities decreased significantly after HD (13.95 ± 2.90 vs. 10.62 ± 2.45). They all correlated with fluid removal by HD (p < 0.01).

Conclusion: Left and right ventricles systolic function, assessed by pulsed TDI, changed significantly after HD whereas diastolic mitral annular velocities seem less sensitive to preload reduction by HD.