Acute Stunning Effect of Hemodialysis on Myocardial Performance: a Three Dimensional Speckle Tracking Echocardiographic Study.

INTRODUCTION: The effects of acute changes during HD on the myocardium are not yet known. The invention of 3DSTE has offered clinicians a new method to assess the movements of ventricular segments simultaneously in three spatial directions. The aim of this study is to evaluate the effect of first weekly standard HD process on the LV and RV global and regional myocardial function in patients with normal LVEF using 3DSTE derived indices METHODS: 38 patients receiving maintenance HD in our clinic who have no known CVD are examined just before and after a HD session using 3DSTE. Demographic and comorbidity data, renal replacement treatment characteristics and laboratory test results are recorded. 3DSTE analysis is performed to calculate the LV global longitudinal, circumferential, area and radial peak systolic strain and RV septum and free-wall longitudinal strain and fractional area change. RESULTS: Patients are aged 52.8 +/- 13.6 years and 52.6 % of them are male. Mean dialysis duration is 56 months. The LV strain values of the patients changed markedly before and after HD [GLS: -14.2 +/- 5.2, -11.1 +/- 4.6 (p<0.001), GCS: -14.8 +/- 4.2, -12.4 +/- 5.28 (p<0.009); GRS: 41.5 +/- 16, 33.3 +/- 16.5 (p=0.003); AREA -24.7 +/- 7.2, -20.1 +/- 7.6 (p=0,001), respectively]. We could not demonstrate any improvement in RV strain values before or after HD. LV strain values are positively correlated with blood pressure variability during the dialysis sessions. LV function is preserved better after HD in patients on beta or calcium channel blocker therapy compared to those who do not use these agents (p<0.001, p<0.01, respectively). CONCLUSION: HD treatment results in deterioration in all LV strain directions but not in RV. Strain assessment may improve vascular risk stratification of patients on chronic HD.