The impact of volume overload on right heart function in end-stage renal disease patients on hemodialysis.

PURPOSE: The aim of this study was to evaluate the impact of volume overload on echocardiographic parameters used for the assessment of the right ventricle (RV) and right atrium (RA), to determine volume-independent parameters and to noninvasively investigate the physio-mechanics of RV and RA by examining end-stage kidney patients before and after hemodialysis (HD).

METHODS: The echocardiographic images were obtained from 67 patients (49.2 ± 17.3 years, 23 f) before and after HD. Changes in echocardiographic parameters with HD were examined. The average ultrafiltrated volume was 3088.1 ± 1103.7 mL.

RESULTS: The size of RV and RA and tricuspid annular plane systolic excursion (TAPSE) decreased after HD, whereas myocardial performance index increased. RV fractional area change and iso-volumetric contraction acceleration time remained unchanged. RV global longitudinal strain (GLS) and RV early diastolic strain rate (SR) decreased after HD. Systolic and late diastolic SR of the RV showed no statistically significant difference after HD. Longitudinal strain and SR of RA contraction were not significantly different after HD. The changes in RV GLS (r = .641, P = .027), RV free wall longitudinal strain (r = .643, P < .001), RA reservoir phase strain (r = .60, P = .008), and TAPSE (r = .642, P = .001) significantly correlated with ultrafiltrated volume.

CONCLUSION: Two-dimensional speckle tracking echocardiography is an easy and noninvasive tool that could provide additional volume-independent echocardiographic parameters and more information on RA physio-mechanics. This might lead to a better evaluation of the cardiac pathophysiology and hemodynamics of patients. Moreover, providing novel volume-independent parameters for the evaluation of right heart chambers would improve the clinical perspectives of patients.