Usefulness of long axis M-mode echocardiographic measurements for optimum dialysis in patients on maintenance hemodialysis: Comparison with changes in plasma levels of atrial natriuretic peptide and brain natriuretic peptide

It has been suggested that analyzing the left ventricular long axis motion can result in the sensitive detection of cardiac functional disorders. Aim: To evaluate the usefulness of left ventricular long axis indices in managing patients on maintenance hemodialysis. Methods: Eighteen hemodialysis patients (mean age 51 +/- 10 years) as well as 16 healthy persons (mean age 49 +/- 9 years) were examined. Echocardiograms were recorded and the plasma concentrations of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) were measured before and after a session of hemodialysis. The following parameters were measured: the left atrial diameter (LAD) and end-diastolic left ventricular diameter (LVDd) from M-mode echocardiograms, the end-diastolic IV volume (LVEDV) and ejection fraction (EF) from 2-D echocardiography, the E/A ratio from transmitral Doppler, the atrial systolic excursion of long axis motion of the mitral ring (ALAM) and maximal lengthening rate of the initial ring toward the left atrium during the early diastolic phase (MLRe) from IV long axis M-mode echocardiograms. Results: LAD, LVDd, LVEDV, and ALAM showed a positive correlation with plasma levels of ANP and BNP. EF, the E/A ratio, and MLRe showed a negative correlation with plasma levels of ANP and BNP. Changes in ALAM and plasma levels of ANP during hemodialysis were larger in the subgroup of ALAM greater than or equal to 0.55 cm before hemodialysis than in the subgroup of ALAM < 0.55 cm before hemodialysis. Conclusion: These results indicate that the left ventricular long axis index can detect a disorder of left ventricular diastolic function, and that a hemodialysis patient whose ALAM before hemodialysis is < 0.55 cm is dialyzed with good volume control conditions.