Diagnosis of left-ventricular diastolic dysfunction in patients with predialysis chronic renal failure
Shutov, A.M.; Kulikova, E.S.; Kondrat'eva, N.I.
Terapevticheskii Arkhiv 75(6): 46-50
2003
ISSN/ISBN: 0040-3660 PMID: 12920959 Document Number: 566457
Aim. To specify effectiveness of different methods for assessment of diastolic function in patients with pre-dialysis chronic renal failure (CRF). Material and methods. Forty non-diabetic pre-dialysis CRF patients (20 males and 20 females, mean age 51 +- 11 years) were studied. Serum creatinine was 209.3 +- 117.4 mcmol/l. 19 patients had chronic heart failure (CHF) of NYHA class I-IlI. M-mode echocardiography and Doppler echocardiography were performed. Transmitral and pulmonary venous flows were assessed by Doppler echocardiography and the flow propagation velocity (Vp) was estimated by color M-mode Doppler echocardiography. The ratio of peak E-wave velocity of transmitral flow to Vp (E/Vp) was calculated. All the patients had preserved systolic function (ejection fraction > 45%). Results. Interpretation of transmitral flow was difficult in 16 (40.0%) patients. During Valsalva's manoeuvre the E-wave peak velocities, the A-wave velocities and the ratio E/A were decreasing. However, we did not reveal any correlation between E/A and NYHA class of heart failure (r = 0.18; p = 0.32). Interpretation of pulmonary venous flow was possible only in 24 (60.0%) patients. Vp estimation by color M-mode Doppler echocardiography improved evaluation of diastolic function in 15 of 16 patients with problems of transmitral flow assessment. A negative correlation was revealed between NYHA class and Vp (r = -0.39; p = 0.013) and a positive correlation was between NYHA class and E/Vp (r = 0.45; p = 0.004). Conclusion. Vp assessed by color M-mode Doppler echocardiography improves the diagnosis of diastolic dysfunction in patients with chronic renal insufficiency. This method has an advantage over pulmonary venous flow investigation. The Valsalva's manoeuvre is low-effective for differential diagnosis of transmitral flow types.