Hemodialysis-induced repetitive myocardial injury results in global and segmental reduction in systolic cardiac function

Abstract

Background and objectives: Hemodialysis (HD)-induced regional wall motion abnormalities (RWMAs) are common in HD patients and driven by ischemia. In nondialysis patients, repeated ischemia leads to chronic reduction in left ventricular (LV) function. HD-induced myocardial ischemia may initiate the same process. We examined the effect of HD-induced repetitive myocardial stunning on global and regional LV function.

Design, setting, participants & measurements: We analyzed data from 30 patients, previously identified as developing HD-induced myocardial ischemia. Serial echocardiographic assessments of global and regional LV performance were performed at baseline and repeated after 12 mo.

Results: Several patients developed segments with a fixed reduction in systolic function of >60% after 1 yr. In this patient group, there was a significant reduction in resting LV ejection fraction (EF) from 61.5 +/- 10.1% to 52.9 +/- 8.6% (P < 0.007). Peak LV EF in response to dialysis also decreased from 59.5 +/- 10% versus 49.9 +/- 6.5% (P < 0.003), with a consequent increase in HD-induced hypotension (P < 0.0001).

Conclusions: HD-induced myocardial stunning may progress over 12 mo to the development of regional fixed systolic dysfunction, consistent with underlying myocardial hibernation and fibrosis. This may be an important and potentially modifiable process in the development of heart failure in HD patients.

Figures

Figure 1.

Change in regional SF over time. There was a significant reduction in SF over 12 mo in those segments that developed RWMAs at baseline (index) compared with those that did not. Values are expressed as mean ± SEM.

Figure 2.

Change in EF at rest and during HD over 12 mo in patients with fixed reductions in segmental function of >60%. The development of fixed segmental reduction in previously stunned myocardial segments was associated with a significant reduction in LV EF at rest and during HD. Values are mean ± SEM.

Figure 3.

Changes in SBP during HD over 12 mo. After 12 mo there was a significant difference in SBP during HD in those patients with new fixed reductions of >60% in previously stunned myocardial segments.