Improvement of left ventricular diastolic function after surgical relieving of hydronephrosis assessed by global longitudinal strain
Resource
Eur. Heart J., 34, 457-457
Journal
European Heart Journal
Pages
P2454
Date Issued
2013
Date
2013
Author(s)
Lin, T. T.
Yeh, C. F.
Wu, C. K.
Tsai, C. T.
Abstract
Purpose: Hydronephrosis due to urolithiasis could result in cytokine releasing and may further lead to cardiac Diastolic Dysfunction (DD). The aim of current study was to evaluate the impact of hydronephrosis on diastolic function by 2D speckle tracking and the possible mechanisms. Methods: Eighty-seven hydronephrosis patients underwent double J placement were enrolled. The controls were matched by age, sex, hypertension, diabetes and renal function. Echocardiohraphy was performed 24 hours before and after operation. Standard 2D Doppler, tissue Doppler imaging, and 2D speckle strain imaging were analyzed offline. Peak diastolic (E$'$) annular velocities was obtained by tissue Doppler imaging, whereas longitudinal strain and strain rate were obtained by speckle tracking. The echocardiographic parameters were compared before and after surgical intervention. Cytokines including interleukin-6, TNF-alpha, N-GAL, TGF-beta, Cystatin-C, KIM-1 were measured by ELISA method before and after surgical procedure. Results: Comparing with the controls, hydronephrosis patients showed no difference in conventional echocardiographic parameters, except a larger left atrium volume index (LAVI) [20.8��7.6 vs. 30.01��11.1ml/m2, P=0.001]. However, hydronephrosis patients had reduced E$'$septal [10.34��2.6 vs. 6.59��2.1 m/s, P<0.001]and higher E/Ea ratio [8.07��2.0 vs. 11.90��3.9, P<0.001] indicated early DD. Significant improvement of atrial systolic function [LAVI, 30.01��11.1 vs. 21.88��8.6ml/m2, P<0.001], longitudinal two-dimensional strain [-16.64��3.2 vs. -17.5��3.3%, P=0.004] and global strain rate during iso-volumetric relaxation (SRIVR) [0.243��0.17 vs. 0.314��0.17 s-1, p<0.001] were observed after operation. In addition, the ratios with early transmitral flow (E/SRIVR) was also decreased after surgery [672.65��148 vs. 316.20��294 m, P=0.028] represented improved DD and decreased Left Ventricle End-Diastolic Pressure (LVEDP). Furthermore, a significant correlation was also found between changes of cytokines and improvement of DD. Conclusions: Hydronephrosis itself could lead to cardiac DD probable through cytokine surge. Relieving of hydronephrosis could aid acute reduction of LVEDP and improvement of DD.
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