Relation between right and left ventricular function in patients undergoing chronic dialysis

Francesco Paneni, Mario Gregori, Giuseppino M. Ciavarella, Sebastiano Sciarretta, Francesca Palano, Giulia Pignatelli, Lorenzo Castello, Alessandro Domenici, Giorgio Punzo, Giuliano Tocci, Luciano De Biase, Paolo Menè, Massimo Volpe

Research output: Contribution to journalArticlepeer-review

Abstract

AIMS: Occurrence of heart failure during dialysis treatment is associated with high mortality. However, mechanisms underlying left ventricular dysfunction (LVD) in these patients are still elusive. In patients undergoing haemodialysis, arteriovenous fistula (AVF) is associated with right ventricular dysfunction (RVD) and a further impairment is observed when AVF is brachial rather than radial. However, it is not known whether AVF-induced RVD is associated with an impaired left ventricular function. We studied the relation between right and left ventricular function in 120 patients undergoing either haemodialysis or peritoneal dialysis and 100 healthy age-matched controls. METHODS: Echocardiography including tissue Doppler imaging (TDI) was performed for both ventricles. Average myocardial performance index (MPI) of the right ventricle (RV MPI) was obtained with a multisegmental approach by using TDI. RESULTS: RVD was higher in haemodialysis than peritoneal dialysis patients and a further increase was observed in haemodialysis patients with brachial access. Interestingly, RV MPI inversely correlated with indices of both left ventricular contraction and relaxation and the association was even stronger in haemodialysis patients, particularly in those with brachial AVF. Of note, dialysis patients in the upper tertile of RV MPI showed the larger impairment of left ventricular function. Regression analyses showed that RV MPI was independently associated with reduced left ventricular function. By contrast, LVD did not significantly affect right ventricular performance in this setting. CONCLUSION: AVF-induced RVD may contribute to LVD in dialysis patients. AVF plays a pivotal role in triggering LVD via right-to-left ventricular interdependence.

Original languageEnglish
Pages (from-to)289-295
Number of pages7
JournalJournal of Cardiovascular Medicine
Volume14
Issue number4
DOIs
Publication statusPublished - Apr 2013

Keywords

  • Arteriovenous fistula
  • Dialysis
  • Heart failure
  • Left ventricular function
  • Right ventricular function
  • Ventricular interdependence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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