Left Ventricular Mass Assessment by 1- and 2-Dimensional Echocardiographic Methods in Hemodialysis Patients: Changes in Left Ventricular Volume Using Echocardiography Before and After a Hemodialysis Session

Charlotte Burup Kristensen; Frank Steensgaard-Hansen; Katrine Aagaard Myhr; Niels Jørgen Løkkegaard; Stine Høyer Finsen; Christian Hassager; Rasmus Møgelvang

doi:10.1016/j.xkme.2020.06.006

Left Ventricular Mass Assessment by 1- and 2-Dimensional Echocardiographic Methods in Hemodialysis Patients: Changes in Left Ventricular Volume Using Echocardiography Before and After a Hemodialysis Session

Kidney Med. 2020 Aug 6;2(5):578-588.e1. doi: 10.1016/j.xkme.2020.06.006. eCollection 2020 Sep-Oct.

Authors

Charlotte Burup Kristensen¹, Frank Steensgaard-Hansen², Katrine Aagaard Myhr¹, Niels Jørgen Løkkegaard², Stine Høyer Finsen³, Christian Hassager¹, Rasmus Møgelvang^{1

4}

Affiliations

¹ The Heart Center, Copenhagen University, Rigshospitalet, Copenhagen, Denmark.
² Department of Internal Medicine, Zealand University Hospital, Holbæk, Denmark.
³ Department of Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark.
⁴ Cardiovascular Research Unit, Svendborg, University of Southern Denmark, Odense, Denmark.

Abstract

Rationale & objective: Left ventricular (LV) mass (LVM) is a predictor of cardiovascular morbidity and mortality and commonly calculated using 1-dimensional (1D) echocardiographic methods. These methods are vulnerable to small measurement errors and LVM may wrongly change according to changes in LV volume (LVV). Less commonly used 2-dimensional (2D) methods can accommodate to the changes in LVV and may be a better alternative among patients receiving hemodialysis (HD) with large fluid fluctuations.

Study design: Observational study.

Setting & participants: Patients with end-stage kidney disease receiving HD.

Exposure: One HD session.

Analytical approach: Transthoracic echocardiography was performed right before and after HD. LVM was calculated using 1D (Devereux, Penn, and Teichholz) and 2D methods (truncated ellipsoid and area-length).

Outcomes: Significant differences in LVM after HD.

Results: We compared dimensions, LVV and LVM, in 53 patients (mean age, 63 ± 15 years; 66% men). For each 1-L increase in ultrafiltration volume (UFV), LV internal diameter decreased 1.1 mm (95% CI, 0.5-1.7 mm; P = 0.001). Patients were divided into 2 groups by the median UFV of 1.6 L. Patients with UFV > 1.6 L had significant smaller LVV and LV internal diameter after HD. LVM calculated using 1D methods decreased according to changes in LVV. Conversely, LVM calculated using 2D methods was not significantly different after HD. No significant change in differences between diastolic - systolic myocardial thickness or LVM as assessed using 1D and 2D methods was observed before and after HD, indicating that LVM remained constant despite HD.

Limitations: We did not use contrast enhancement, 3-dimensional methods, or cardiac magnetic resonance.

Conclusions: LVM calculated using 2D methods, truncated ellipsoid and area-length, is less affected by fluctuations in fluid and LVV, in contrast to 1D methods. Complementary LVM calculation using 2D methods is encouraged, especially in patients with large fluid fluctuations in which increased LVM using a 1D method has been detected.

Keywords: Echocardiography; end-stage renal disease; hemodialysis; left ventricular mass; preload.