Abstract 11230: Relationship Between Natriuretic Peptide and Pulmonary Capillary Wedge Pressure Estimated by Three-Dimensional Speckle Tracking Echocardiography in Patients With Dialysis
Background: Left ventricular (LV) abnormalities can be detected by measurement of B-type natriuretic peptide (BNP) and hemodialysis patients with cardiovascular disease have especially high plasma BNP concentration. Atrial natriuretic peptide (ANP) in dialysis patients is higher pre-dialysis associated with the elevated LA pressure than post dialysis and may be useful to set up dry weight through dialysis session. However, reliable echocardiographic parameters to set up dry weight in dialysis patients are not elucidated.
Methods: We reported that pulmonary capillary wedge pressure (ePCWP) could be accurately estimated by combined assessment of LA volume (LAV) and emptying function (EF) using a speckle tracking echocardiography (STE) (r=0.9). We estimated the ePCWP by this method with 3-dimensional (3D) STE and measured BNP and ANP before and after dialysis session in consecutive 60 patients (age: 61±13, 36 men). The ePCWP is calculated as 10.7 - 12.4 x log (LA active EF / minimum LAV index). LA active EF is defined as (pre-atrial contraction LAV - minimum LAV) / pre-atrial contraction LAV x 100%.
Results: There was no significant difference in LV mass between pre and post dialysis (122±27 vs. 123±28g/m2, respectively). LV ejection fraction was increased from 67±6 to 68±7% (p<0.05) after dialysis, and E/e’ was decreased from 13.2±3.9 to 10.7±3.3 (p<0.05) after dialysis. The ePCWP was significantly decreased from 8.8±2.7 to 6.3±2.0mmHg (p<0.01) after dialysis associated with the reduction of both ln BNP (from 4.8±1.1 to 4.3±1.0, p<0.01) and ln ANP (from 4.9±0.6 to 3.7±0.5, p<0.01), and also associated with the reduction of body weight (BW) (from 58.3±11.9 to 56.0±11.4kg, p<0.05). There was a good relation between ePCWP and ln BNP or ln ANP before and after dialysis (r=0.76 and r=0.68, r=0.57 and r=0.62, p<0.01, respectively), and also between % reduction of BW and % change of ePCWP (r=0.71, p<0.01).
Conclusions: The ePCWP was easily estimated by 3D-STE. The ePCWP had a good correlation with BNP, ANP and BW reduction in dialysis patients. The ePCWP assessed by 3D-STE may be useful to determine the amount of fluid removal during a dialysis and have an incremental value in treatment of dialysis patients.
- © 2013 by American Heart Association, Inc.