Coronary Flow and Cardiac Function During Dialysis

Heart failure develops in 20-25% of patients on chronic dialysis. Coronary flow reserve is reduced even in the absence of obstructive coronary artery disease in dialysis patients. Sampling of coronary artery flow velocities is feasible using trans-thoracic Doppler echocardiography (TTE).

Aim:
To test the hypothesis that dialysis reduces coronary flow and alters cardiac function.

Method:
Twenty five patients, age 71±10yrs , 40% with heart failure were studied. TTE was performed before, during and immediately after hemodialysis. Doppler Sampling of blood velocities in the left anterior descending coronary artery (LAD) was performed.

Results:
No ischemic or other serious event occurred during or after dialysis. During dialysis, left ventricular end-diastolic diameter, and velocities through the mitral and aortic, valves decreased significantly. While right ventricular longitudinal function decreased significantly during dialysis, tricuspid and pulmonary valves velocities remained without change. Myocardial performance index did not change significantly. Diastolic blood velocity in the LAD decreased from 38±12 to 31±10 cm/sec, p Conclusion: Hemodialysis is associated with reduction in left side cardiac chamber diameters and velocities; coronary flow velocities is reduced but with maintenance of blood supply/ demand ratio and thus without ischemia.