Doppler tissue imaging and color M-mode flow propagation velocity: are they really preload independent?

Objective: This study investigated the change in new diastolic indexes in patients with uremia who undergo regular hemodialysis (H/D).

Methods: We studied 81 patients with uremia (41 men and 40 women) receiving regular H/D. All patients were in sinus rhythm before H/D. They had normal left ventricular systolic performance without regional wall-motion abnormality. Three patients were excluded because of atrial fibrillation after H/D. Patients were separated by the amount of body fluid removed during H/D procedure: 30 patients with H/D amount less than 2 kg (group 1), 33 patients with H/D amount between 2 and 3 kg (group 2), and 18 patients with H/D amount larger than 3 kg (group 3). They received complete transthoracic echocardiographic examinations. Flow propagation velocity (FPV) was measured by color M-mode echocardiography in apical 4-chamber view. Mitral annulus Doppler tissue velocities (peak systolic [Sa], early diastolic [Ea], and late diastolic [Aa]) were measured from septal, lateral, inferior, and posterior walls. All these parameters were obtained immediately before and after H/D. Paired data were compared.

Results: In patients with removed fluid amount less than 2 kg (group 1), the change of all diastolic parameters showed insignificant change except FPV (peak mitral E, P = .14; peak mitral A, P = .916; FPV, P = .009; septal Sa, P = .173; septal Ea, P = .295; septal Aa, P = .649). In patients with H/D amount between 2 and 3 kg, the change of all diastolic parameters showed statistically significant difference except Sa (peak mitral E, P = .001; peak mitral A, P = .001; FPV, P = .001; Sa, P = .589; Ea, P = .001; Aa, P = .015). In patients with H/D amount larger than 3 kg, Sa still showed insignificant change. Ea, Aa, and FPV showed significant difference after H/D (peak mitral E, P = .001; peak mitral A, P = .035; FPV, P = .008; septal Sa, P = .777; septal Ea, P = .014; septal Aa, P = .048).

Conclusion: In patients with normal left ventricular systolic function, FPV was preload dependent. Diastolic phase mitral annulus Doppler tissue velocities (Ea and Aa) behaved differently according to the amount removed during H/D. They were preload independent when the amount removed during H/D was less than 2 kg. When the amount removed during H/D was larger than 2 kg, diastolic phase mitral annulus Doppler tissue velocities changed significantly. That is to say, diastolic phase mitral annulus Doppler tissue velocities were not totally preload independent. For systolic phase mitral annulus Doppler tissue velocity index (Sa), it was preload independent.