Lung ultrasound guided dry-weight reduction and echocardiographic changes in clinically euvolemic hypertensive hemodialysis patients: 12-month results of a randomized controlled trial.
Hellenic J Cardiol 2021;
64:1-6. [PMID:
34856379 DOI:
10.1016/j.hjc.2021.11.002]
[Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/12/2021] [Accepted: 11/22/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND
Left ventricular hypertrophy (LVH) and dysfunction are highly prevalent in hemodialysis patients and independently associated with adverse outcomes. This study examines the long-term effects of dry-weight reduction with a standardized lung-ultrasound (US)-guided strategy on echocardiographic indexes of left ventricular (LV) mass and function in hemodialysis patients.
METHODS
Seventy-one clinically euvolemic, hemodialysis patients with hypertension were randomized to dry-weight reduction guided by pre-hemodialysis lung US (n=35) or standard-of-care treatment (n=36) and were followed-up for 12 months. Two-dimensional and tissue-Doppler echocardiography (TDI) were performed at baseline and study-end.
RESULTS
During follow-up, dry-weight reduction took place in more patients in the active than in the control arm of the trial (71.4% vs 22.2%; p<0.001). Left atrial (LA) surface (-1.37±4.50 vs 1.28±5.00 cm2; P=0.006) and LA volume index (-3.22±11.82 vs 4.76±12.83 ml/m2; P=0.009) decreased in the active and increased in the control group. LV end-diastolic volume (-0.94±11.45 vs 6.58±13.92 ml/m2; P=0.015) decreased only in the active group. LV mass index was unchanged in the active (134.21±44.75 vs 133.57±45.51; P=0.844) and marginally increased in the control group (134.21±40.96 vs 143.77±50.04 g/m2; P=0.089). LV E/e' wave ratio was unchanged in the active (12.45±4.69 vs 12.56±4.89; P=0.521) and increased in the usual-care group (10.91±4.97 vs12.36±6.43; P=0.003). LV systolic function did not differ among the two study arms across the trial.
CONCLUSIONS
Over 12 months, lung-US-guided dry-weight reduction is associated with reverse LV and LA remodeling, myocardial hypertrophy regression and improved LV diastolic filling properties.
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