Tehran University Medical Journal

Background: Cardiovascular problems including arterial hypertension, coronary artery diseases, congestive heart failure are prevalent among chronic hemodialyzed patients. Ultrafiltration of hemodialyzed patient's serum, which culminating in intravascular volume reduction, is frequently used during hemodialysis. One of the restrictions of the echocardiographic evaluation of the diastolic heart function is the intravascular volume dependency of some echocardiographic parameters. In this study we have evaluated the volume dependency of certain echocardiography parameters in chronically hemodialyzed patients.

Methods: Thirteen patients undergoing chronic hemodialysis in Ghaem Hospital Hemodialysis Center in Mashhad, Iran, were evaluated one hour before and immediately after hemodialysis for the following: all diastolic echocardiographic parameters, left ventricular function, left ventricular systolic function, inferior vena cava (IVC) diameter and IVC collapsibility with inspiration, and systolic and diastolic blood pressure. The echocardiographic parameters were analyzed using the paired Student's t-test.

Results: With hemodialysis, there was no significant change in left ventricular function, A wave amplitude and E/F slope, however, there was a significant reduction of the E wave amplitude, increment in E wave deceleration time (p= 0.001, t=-4.14) and a decrease in the E/A ratio (p=0.03, t=2.46). Tissue Doppler echocardiography showed no significant change in mitral annular diastolic motion, E'/A' waves, with hemodialysis (p=0.728, t= - 0.356), although there was a reduction of the E/E' ratio.

Conclusion: Tissue Doppler imaging and color M-mode echocardiographic parameters are independent of the intravascular value status. With no change associated with hemodialysis, these parameters can be used as reliable criteria for evaluating ventricular diastolic function even when the volume status varies.

Background: Evaluation of diastolic dysfunction and its relationship with TIMI frame count in patients with stable coronary artery disease referred to Ayatollah Taleghani Hospital in Tehran in the years 2010-2011 is the purpose of this study.
Methods: Patients were divided into two groups: case and control. Both groups had chronic angina. Patient information on check list has been studies based on data provided by angiography and echocardiography methods.
Results: Cases had significantly higher values of corrected TIMI frame count (TFC) for the left anterior desending artery (LAD), TFC for Circumflex artery (Cx) & Right coronary artery (RCA), (mean TFC P<0.001). Conventional echocardiography showed significantly lower maximal peak systolic velocity (sm) (cm/s), Correlation of early diastolic velocity at myocardial segments (Em) & peak systolic velocity at myocardial segments (Sm) with mean TFC in all 3 vessels were significant (P=0/0001). Ratio of maximal early to late diastolic filling (E/A), in patient with TFC≥ 21 was 0/7 & in patients with TFC≤21 was 1. DT (Deceleration time) had no significant correlation with TFC. Mean of isovolumetric relaxation time (IVRT) in cases was 91 m/s & in controls was 72 m/s Which was higher in patients with mean TFC ≥21. Correlation between mean of angiography and diastolic disfunction was significant.
Conclusion: According to this study diastolic dysfunction which estimated by echocardiography showed significant correlation with TIMI frame count in chronic stable angina patients. Due to simplicity, low cost, quality and reproducibility of this method, this will be helpful.