Coronary microcirculation and left ventricular diastolic function: comparison between patients on hemodialysis and perit
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ORIGINAL INVESTIGATION
Coronary microcirculation and left ventricular diastolic function: comparison between patients on hemodialysis and peritoneal dialysis Ioannis Gkirdis1 · Katerina K. Naka1 · Lampros Lakkas1 · Panagiota Manolakaki3 · Anila Duni2 · Konstantinos Koulousios3 · Rigas Kalaitzidis2 · Evangelia Dounousi2 · Lampros K. Michalis1 · Christos S. Katsouras1 Received: 16 June 2020 / Revised: 31 August 2020 / Accepted: 16 September 2020 © Japanese Society of Echocardiography 2020
Abstract Background End-stage renal disease is considered to influence coronary microcirculation and left ventricular (LV) diastolic function. We investigated whether differences exist in LV diastolic function indices and coronary flow reserve (CFR) between patients on hemodialysis (HD) and peritoneal dialysis (PD). Methods A complete transthoracic echocardiographic study was performed on 21 HD and 22 PD patients and LV diastolic function was evaluated. CFR was estimated using transthoracic Doppler echocardiography on the left anterior descending artery, during high-dose dypiridamole infusion. Results HD and PD groups did not differ regarding Doppler-derived diastolic indices, but they significantly differed in the frequency of severe LV hypertrophy (38.1% in HD vs 4.5% in PD group, p = 0.009) and grade II diastolic dysfunction (42.9% in HD vs 4.5% in PD group, p = 0.004). No patient had restrictive filling pattern. There was no difference in the prevalence of arterial hypertension and diabetes mellitus in patients with grade II vs less than grade II dysfunction. Mean CFR was similar in the HD and PD groups (2.25 ± 0.65 vs 2.36 ± 0.76, p = 0.635) and lower in patients with grade II diastolic dysfunction (1.87 ± 0.43 vs 2.44 ± 0.72, p = 0.023) and diabetes (1.70 ± 0.59 vs 2.39 ± 0.68, p = 0.04). LV mass index was negatively associated with CFR (r = − 0.308, p = 0.045). Conclusion Patients on HD had more advanced diastolic dysfunction compared to PD, independently of the presence of hypertension and diabetes. CFR did not differ between HD and PD patients, but it was significantly lower in diabetics and in patients with more advanced diastolic dysfunction. Keywords Coronary flow reserve · Diastolic dysfunction · Echocardiography · Hemodialysis · Peritoneal dialysis
Introduction Left ventricular (LV) diastolic dysfunction displays a high prevalence and a strong prognostic importance for cardiovascular events in patients with end-stage renal disease (ESRD) [1–4]. Although its associations with LV hypertrophy (LVH), arterial hypertension and diabetes mellitus (DM) * Ioannis Gkirdis [email protected] 1
Second Department of Cardiology, University Hospital of Ioannina, Stavrou Niarchou Avenue, 45500 Ioannina, Greece
2
Department of Nephrology, University Hospital of Ioannina, Ioannina, Greece
3
Department of Nephrology, General Hospital of Ioannina “G. Hatzikosta”, Ioannina, Greece
have been consistently investigated in the ESRD population [5–8], studies comparing the influence of different dialysis methods on LV
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