Echocardiographic evaluation of right heart functions in hemodialysis patients



Right heart functions, Tricuspid annular plane systolic excursion, Systolic pulmonary artery pressure, Hemodialysis


Aim: Volume load assessment is an important problem in patients with chronic renal failure (CRF). Apart from classical volume assessment methods, the number of studies on echocardiographic evaluation of right heart functions is limited. In this study, we aimed to evaluate right heart functions echocardiographically in end-stage renal failure patients receiving hemodialysis (HD) therapy and its utility in volume load determination.

Methods: This case-control study included 49 patients receiving HD treatment as the study group. The control group consisted of 46 healthy individuals whose age and gender were matched. Echocardiographic evaluation was performed for all participants. Tricuspid annular plane systolic excursion (TAPSE), systolic pulmonary artery pressure (SPAB), tricuspid E wave velocity, A wave velocity, E / A ratio, right ventricular ejection fraction (RVEF) and left ventricular ejection fraction (LVEF) were measured.

Results: Right ventricular diastolic diameter (2.55 (0.3) vs 2.30 (0.29) respectively, P<0.001) SPAP (37.4 (8.3) vs 19 (6.8), P<0.001, respectively) were statistically significant higher in the study group, while TAPSE (1.61 (0.35) vs 2.09 (0.27), P<0.001, respectively), A rate, (0.63 (0.27) vs 0.45 (0.26), P<0.001, respectively), E / A ratio (0.93 (0.25) vs 1.37 (0.24), P<0.001, respectively) were significantly lower. Right ventricular (RV) E velocity was insignificantly lower in the study group (P=0.523). There were no statistically significant differences between the groups in terms of age, gender, and body mass index.

Conclusion: In our study, we found that TAPSE was low and SBAP and RV diastolic diameter were high in HD patients. We think that TAPSE and SPAB can be used together with conventional methods for evaluating hypervolemia in HD patients. Further studies are required to explore this clinical tool.


Download data is not yet available.


Foley RN, Parfrey PS, Harnett JD, Kent GM, Martin CJ, Murray DC, et al. Clinical and echocardiographic disease in patients starting end-stage renal disease therapy. Kidney Int. 1995 Jan;47(1):186-92.

US Renal Data System 1999 Annual Data Report. Am J Kidney Dis 1999; 34 (2 Suppl1): S1-176.

Valderrabano F, Berthoux FC, Jones EHP, Mehls O. Report on management of renal failure in Europe, XXV, 1994. End-stage renal disease and dialysis report. Nephrol Dial Transplant. 1996; 11(Suppl.1):2-21.

Meyer KB, Levey AS. Controlling the epidemic of cardiovascular disease in chronic renal disease: a report from the National Kidney Foundation Task Force on cardiovascular disease. J Am Soc Nephrol. 1998;9:S31-42.

Paoletti E, Bellino D, Cassottana P, Rolla D, Cannella G. Left ventricular hypertrophy in nondiabetic predialysis CKD. Am J Kidney Dis. 2005;46:320–7.

Stewart GA, Gansevoort RT, Mark PB, Rooney E, McDonagh TA, Dargie HJ, et al. Electrocardiographic abnormalities and uremic cardiomyopathy. Kidney Int. 2005;67:217–26.

Henderson LW. Symptomatic hypotension during hemodialysis. Kidney Int. 1980 May;17(5):571-6.

Blumberg A, Nelp WD, Hegstrom RM, Scribner BH. Extracellular volume in patients with chronic renal disease treated for hypertension by sodium restriction. Lancet. 1967;2:6973.

Charra B, Calemard E, Ruffet M. Survival as an index of adequacy of dialysis. Kidney Int. 1992;41:1286-91.

Foley RN, Parfrey PS, Sarnak MJ. Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis. 1998;32(5 Suppl 3):112-9.

Franco V. Right ventricular remodelling in pulmonary hypertension. Heart Failure Clicic. 2012;8:403-12.

Eidem BW, O’Leary PW, Tei C, et al. Usefulness of the myocardial performance index for assessing right ventricular function in congenital heart disease. Am J Cardiology. 2000;86:654-8.

Greil GF, Beerbaum P, Razavi R, et al. Imaging the right ventricle. Heart. 2008;94:803-8.

Kjaergaard J, Schaadt BK, Lund JO, et al. Quantification of right ventricular function in acute pulmonary embolism: relation to extent of pulmonary perfusion defects. European J Echocardiography. 2008;9:641–5.

Maffessanti F, Gripari P, Tamborini G, et al. Evaluation of right ventricular systolic function after mitral valve repair: a two-dimensional Doppler, speckle-tracking, and three-dimensional echocardiographic study. J Am Society Echocardiography. 2012;25:701–8.

Oguzhan A, Abaci A, Eryol NK, et al. Colour tissue Doppler echocardiographic evaluation of right ventricular function in patients with right ventricular infarction. Cardiology. 2003;100:41–6.

Pleister A, Kahwash R, Haas G, et al. Echocardiography and heart failure: a glimpse of the right heart. Echocardiography. 2014;32:95–107.

Simonneau G, et al. Updated clinical classification of pulmonary hypertension. J Am Coll Cardiology. 2013;62:34‑41.

Rubin LJ. Pathology and pathophysiology of primary pulmonary hypertension. Am J Cardiology. 1995;75:51A‑54A.

Hoeper MM, Bogaard HJ, Condliffe R, Frantz R, Khanna D, Kurzyna M, et al. Definitions and diagnosis of pulmonary hypertension. J Am Coll Cardiology. 2013;62:D42‑50.

Galiè N, Hoeper MM, Humbert M, et al. Task Force for Diagnosis and Treatment of Pulmonary Hypertension of European Society of Cardiology (ESC), European Respiratory Society (ERS), International Society of Heart and Lung Transplantation (ISHLT), Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Respir J. 2009;34:1219‑63.

Forfia PR, Vachiéry JL. Echocardiography in pulmonary arterial hypertension. Am J Cardiol. 2012;110:16S‑24S.

Currie PJ, Seward JB, Chan KL, Fyfe DA, Hagler DJ, Mair DD, et al. Continuous-wave Doppler determination of right ventricular pressure: A simultaneous Doppler‑catheterization study in 127 patients. J Am Coll Cardiol. 1985;6:750‑6.

Lanzarini L, Fontana A, Lucca E, Campana C, Klersy C. Noninvasive estimation of both systolic and diastolic pulmonary artery pressure from Doppler analysis of tricuspid regurgitant velocity spectrum in patients with chronic heart failure. Am Heart J. 2002;144:1087‑94.

Strange G, Playford D, Stewart S, Deague JA, Nelson H, Kent A, et al. Pulmonary hypertension: Prevalence and mortality in the Armadale echocardiography cohort. Heart. 2012;98:1805‑11.

de Simone G, Devereux RB, Ganau A, Hahn RT, Saba PS, Mureddu GF, et al. Estimation of the left ventricular chamber and stroke volume by limited M-mode echocardiography and validation by two-dimensional and Doppler echocardiography. Am J Cardiol. 1996;78:801–7.

Teichholz LE, Kreulen T, Herman MV, Gorlin R. Problems in echocardiographic volume determinations: Echocardiographic-angiographic correlations in the presence of absence of asynergy. Am J Cardiol. 1976;37:7–11.

Koestenberger M, Ravekes W, Everett AD, Stueger HP, Heinzl B, Gamillscheg A, et al. Right ventricular function in infants, children, and adolescents: Reference values of the tricuspid annular plane systolic excursion (TAPSE) in 640 healthy patients and calculation of z score values. J Am Soc Echocardiography. 2009;22:715-9.

Best PJ, Holmes DR. Chronic kidney disease as a cardiovascular risk factor. Am Heart J. 2003;145:383–6.

López-Candales A, Rajagopalan N, Saxena N, Gulyasy B, Edelman K, Bazaz R. Right ventricular systolic function is not the sole determinant of tricuspid annular motion. Am J Cardiol. 2006;98:973-7.

Kucukdurmaz Z, Karapinar H, Karavelioğlu Y, Açar G, Gul I, Emiroglu MY, et al. Effect of blood donation mediated volume reduction on right ventricular function parameters in healthy subjects. Echocardiography. 2012;29:451-4.

López-Candales A, Dohi K, Bazaz R, Edelman K. Relation of right ventricular free wall mechanical delay to right ventricular dysfunction as determined by tissue Doppler imaging. Am J Cardiology. 2005;96:602-6.

Akyüz A, Yıldız A, Akıl MA, et al. Assessment of right ventricular systolic function in patients with chronic renal failure before and after hemodialysis by means of various echocardiographic modalities. Arch Turk Soc Cardiology. 2014;42(8):717-725 doi: 10.5543/tkda.2014.57609.

Karavelioğlu Y, Özkurt S, Kalçik M, Karapinar H, Arisoy A. Echocardiographic assessment of right ventricular functions in nondiabetic normotensive hemodialysis patients. Interv Med Appl Sci. 2015;7(3):95-101.

Kawar B, Ellam T, Jackson C, Kiely DG. Pulmonary hypertension in renal disease: Epidemiology, potential mechanisms and implications. Am J Nephrol. 2013;37:281‑90.

Di Lullo L, Floccari F, Polito P. Right ventricular diastolic function in dialysis patients could be affected by vascular access. Nephron Clin Pract. 2011;118:c257‑61.

Momtaz M, Al Fishawy H, Aljarhi UM, Al-Ansi RZ, Megid MA, Khaled M. Right ventricular dysfunction in patients with end-stage renal disease on regular hemodialysis. Egypt J Intern Med. 2013;25:127–32.

Charra B, Bergstrom J, Scribner BH. Blood pressure control in dialysis patients: importance of the lag phenomenon. Am J Kidney Dis. 1998; 32:720–4.

Locatelli F, Manzoni C. Duration of dialysis sessions–was Hegel right? Nephrol Dial Transplant. 1999;14:560–3.







Research Article

How to Cite

Ardahanlı İsa, Akyüz O. Echocardiographic evaluation of right heart functions in hemodialysis patients. J Surg Med [Internet]. 2019 Dec. 3 [cited 2024 Apr. 23];3(12):820-4. Available from: