Effect of hemodialysis on left atrial function in patients with end‐stage renal failure evaluated by two‐dimensional speckle tracking imaging

• Published in: Echocardiography (Mount Kisco, N.Y.) Vol. 41; no. 2; pp. e15784 - n/a
• Main Authors: Miao, Yunxiang, Wang, Li, Yin, Ying, Zhou, Bingyuan, Liao, Yuping
• Format: Journal Article
• Language: English
• Published: United States 01.02.2024
• Subjects: end stage renal disease; hemodialysis; left atrial strain; speckle tracking imaging; hemodialysis; end stage renal disease; speckle tracking imaging; left atrial strain
• ISSN: 0742-2822; 1540-8175; 1540-8175
• DOI: 10.1111/echo.15784

Objective We sought to evaluate the left atrial (LA) strain parameters of maintenance hemodialysis (MHD) patients before and after dialysis by two dimensional speckle tracking imaging (2D‐STI), and to explore the effect of volume load change on LA function. Methods Seventy‐six patients with end stage renal disease (ESRD) on hemodialysis (HD) were enrolled in the study protocol. The median duration of dialysis was 24.0 (7.5, 59.5) months. In addition, 30 healthy subjects were selected as control group. Comprehensive echocardiography was performed immediately before and after hemodialysis to compare the changes in left atrial function. Results Regarding LA strain parameters in patients of pre‐HD, the median (25th, 75th) LA reservoir, LA conduit, and LA contractile reserve were 28.0 (23.0, 34.5), −15.5 (−10.0, −21.5), −12.0 (−9.0, −16.0) respectively; the post‐HD were 26.0 (21.0, 29.0), −12.0 (−9, −15.5), −12.5 (−9, −15.5) respectively; and controls were 43.0 (36.0, 48.0), −24.0 (−18.0, −32.0), −17.0 (−15.0, −22.0) respectively. The left atrial strain parameters before HD were lower than controls, the differences were statistically significant, the p‐value were .000, .025, and .000, respectively. The reservoir function and conduit function of LA strain decreased after hemodialysis, the differences were statistically significant, the p‐value were .003 and .006, respectively. Regarding the contraction of LA, the differences between pre‐ and post‐HD were not statistically significant (p = .965). Conclusion Hemodialysis removes excess water in human body, while LVGLS and Doppler parameters are greatly affected by reduced preload. New echocardiographic parameters, such as left atrial strain, can quantitatively evaluate the changes in left atrial function before and after hemodialysis in ESRD patients, which can provide valuable information for the overall cardiac evaluation in this specific population. The picture shows the left atrial strain curves. Panel a: results of pre‐HD; Panel b: results of post‐HD. (LASr: left atrial strain during reservoir phase, LAScd: left atrial strain during conduit phase, LASct: left atrial strain during contraction phase). After hemodialysis, the passive function of atrium (LASr, LAScd) is greatly affected by volume load, while the active deformation (LASct) is less affected. Left atrial strain parameters can quantitatively evaluate LA dysfunction in ESRD patients, which can provide valuable information for the overall cardiac evaluation in this specific population.