Jann P Ong1,2, Ron Wald2,3, Marc B Goldstein2,3, Jonathon Leipsic4, Mercedeh Kiaii5, Djeven P Deva2,6, Anish Kirpalani2,6, Laura Jimenez-Juan2,7, Olugbenga Bello1, Paymon M Azizi2, Rachel M Wald2,8, Graham A Wright2,9, Ziv Harel2,3, Kim A Connelly1,2, Andrew T Yan1,2. 1. Division of Cardiology, St. Michael's Hospital, Toronto, Ontario, Canada. 2. University of Toronto, Toronto, Ontario, Canada. 3. Division of Nephrology, St Michael's Hospital, and Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada. 4. Department of Radiology and Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada. 5. Division of Nephrology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada. 6. Department of Medical Imaging, St. Michael's Hospital, Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada. 7. Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. 8. Division of Cardiology, Toronto General Hospital, Toronto, Ontario, Canada. 9. Schulich Heart Program and the Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Abstract
AIM: Intensified haemodialysis is associated with regression of left ventricular (LV) mass. Compared to LV ejection fraction, LV strain allows more direct assessment of LV function. We sought to assess the impact of in-centre nocturnal haemodialysis (INHD) on global LV strain (radial, circumferential, and longitudinal) and torsion by cardiac MRI (CMR). METHODS: In this prospective, two-centre cohort study, 37 participants on conventional haemodialysis (CHD, 3-4 h/session for three sessions/week) converted to INHD (7-8 h/session for three sessions/week) and 30 participants continued CHD. Participants underwent CMR using a standardized protocol and had biomarker measurements at baseline and 52 weeks. RESULTS: Among the 55 participants (mean age 55; 40% women) with complete CMR data, those who converted to INHD had a significant improvement in their global circumferential strain (GCS, P = 0.025), while those continuing CHD did not have any significant changes in LV strain. When the two groups were compared, there was significant improvement in torsion. LV strains were significantly correlated with each other, but not with troponin I, C-reactive protein, or brain natriuretic protein (NT-proBNP), except for global longitudinal strain (GLS) with troponin I (P = 0.001) and NT-proBNP (P = 0.038). CONCLUSION: Conversion to INHD was associated with significant improvement in GCS over one year of study, although comparisons with the CHD group were not significant. There was also a significant decrease in torsion in the INHD group compared with CHD. Improvement in LV regional function would support the notion that INHD has favourable effects on both LV structure and function.
AIM: Intensified haemodialysis is associated with regression of left ventricular (LV) mass. Compared to LV ejection fraction, LV strain allows more direct assessment of LV function. We sought to assess the impact of in-centre nocturnal haemodialysis (INHD) on global LV strain (radial, circumferential, and longitudinal) and torsion by cardiac MRI (CMR). METHODS: In this prospective, two-centre cohort study, 37 participants on conventional haemodialysis (CHD, 3-4 h/session for three sessions/week) converted to INHD (7-8 h/session for three sessions/week) and 30 participants continued CHD. Participants underwent CMR using a standardized protocol and had biomarker measurements at baseline and 52 weeks. RESULTS: Among the 55 participants (mean age 55; 40% women) with complete CMR data, those who converted to INHD had a significant improvement in their global circumferential strain (GCS, P = 0.025), while those continuing CHD did not have any significant changes in LV strain. When the two groups were compared, there was significant improvement in torsion. LV strains were significantly correlated with each other, but not with troponin I, C-reactive protein, or brain natriuretic protein (NT-proBNP), except for global longitudinal strain (GLS) with troponin I (P = 0.001) and NT-proBNP (P = 0.038). CONCLUSION: Conversion to INHD was associated with significant improvement in GCS over one year of study, although comparisons with the CHD group were not significant. There was also a significant decrease in torsion in the INHD group compared with CHD. Improvement in LV regional function would support the notion that INHD has favourable effects on both LV structure and function.
Authors: Sean Cai; Ron Wald; Djeven P Deva; Mercedeh Kiaii; Ming-Yen Ng; Gauri R Karur; Oblugbenga Bello; Zhuo Jun Li; Jonathon Leipsic; Laura Jimenez-Juan; Anish Kirpalani; Kim A Connelly; Andrew T Yan Journal: J Nephrol Date: 2019-11-14 Impact factor: 3.902