Cardioprotective Effect of Acute Intradialytic Exercise: A Comprehensive Speckle-Tracking Echocardiography Analysis.
Journal
Journal of the American Society of Nephrology : JASN
ISSN: 1533-3450
Titre abrégé: J Am Soc Nephrol
Pays: United States
ID NLM: 9013836
Informations de publication
Date de publication:
01 08 2023
01 08 2023
Historique:
received:
02
11
2022
accepted:
30
03
2023
pmc-release:
01
08
2024
medline:
2
8
2023
pubmed:
19
4
2023
entrez:
18
4
2023
Statut:
ppublish
Résumé
Hemodialysis (HD) can lead to acute left ventricular (LV) myocardial wall motion abnormalities (myocardial stunning) due to segmental hypoperfusion. Exercise during dialysis is associated with favorable effects on central hemodynamics and BP stability, factors considered in the etiology of HD-induced myocardial stunning. In a speckle-tracking echocardiography analysis, the authors explored effects of acute intradialytic exercise (IDE) on LV regional myocardial function in 60 patients undergoing HD. They found beneficial effects of IDE on LV longitudinal and circumferential function and on torsional mechanics, not accounted for by cardiac loading conditions or central hemodynamics. These findings support the implementation of IDE in people with ESKD, given that LV transient dysfunction imposed by repetitive HD may contribute to heart failure and increased risk of cardiac events in such patients. Hemodialysis (HD) induces left ventricular (LV) transient myocardial dysfunction. A complex interplay between linear deformations and torsional mechanics underlies LV myocardial performance. Although intradialytic exercise (IDE) induces favorable effects on central hemodynamics, its effect on myocardial mechanics has never been comprehensively documented. To evaluate the effects of IDE on LV myocardial mechanics, assessed by speckle-tracking echocardiography, we conducted a prospective, open-label, two-center randomized crossover trial. We enrolled 60 individuals with ESKD receiving HD, who were assigned to participate in two sessions performed in a randomized order: standard HD and HD incorporating 30 minutes of aerobic exercise (HDEX). We measured global longitudinal strain (GLS) at baseline (T0), 90 minutes after HD onset (T1), and 30 minutes before ending HD (T2). At T0 and T2, we also measured circumferential strain and twist, calculated as the net difference between apical and basal rotations. Central hemodynamic data (BP, cardiac output) also were collected. The decline in GLS observed during the HD procedure was attenuated in the HDEX sessions (estimated difference, -1.16%; 95% confidence interval [95% CI], -0.31 to -2.02; P = 0.008). Compared with HD, HDEX also demonstrated greater improvements from T0 to T2 in twist, an important component of LV myocardial function (estimated difference, 2.48°; 95% CI, 0.30 to 4.65; P = 0.02). Differences in changes from T0 to T2 for cardiac loading and intradialytic hemodynamics did not account for the beneficial effects of IDE on LV myocardial mechanics kinetics. IDE applied acutely during HD improves regional myocardial mechanics and might warrant consideration in the therapeutic approach for patients on HD.
Sections du résumé
SIGNIFICANCE STATEMENT
Hemodialysis (HD) can lead to acute left ventricular (LV) myocardial wall motion abnormalities (myocardial stunning) due to segmental hypoperfusion. Exercise during dialysis is associated with favorable effects on central hemodynamics and BP stability, factors considered in the etiology of HD-induced myocardial stunning. In a speckle-tracking echocardiography analysis, the authors explored effects of acute intradialytic exercise (IDE) on LV regional myocardial function in 60 patients undergoing HD. They found beneficial effects of IDE on LV longitudinal and circumferential function and on torsional mechanics, not accounted for by cardiac loading conditions or central hemodynamics. These findings support the implementation of IDE in people with ESKD, given that LV transient dysfunction imposed by repetitive HD may contribute to heart failure and increased risk of cardiac events in such patients.
BACKGROUND
Hemodialysis (HD) induces left ventricular (LV) transient myocardial dysfunction. A complex interplay between linear deformations and torsional mechanics underlies LV myocardial performance. Although intradialytic exercise (IDE) induces favorable effects on central hemodynamics, its effect on myocardial mechanics has never been comprehensively documented.
METHODS
To evaluate the effects of IDE on LV myocardial mechanics, assessed by speckle-tracking echocardiography, we conducted a prospective, open-label, two-center randomized crossover trial. We enrolled 60 individuals with ESKD receiving HD, who were assigned to participate in two sessions performed in a randomized order: standard HD and HD incorporating 30 minutes of aerobic exercise (HDEX). We measured global longitudinal strain (GLS) at baseline (T0), 90 minutes after HD onset (T1), and 30 minutes before ending HD (T2). At T0 and T2, we also measured circumferential strain and twist, calculated as the net difference between apical and basal rotations. Central hemodynamic data (BP, cardiac output) also were collected.
RESULTS
The decline in GLS observed during the HD procedure was attenuated in the HDEX sessions (estimated difference, -1.16%; 95% confidence interval [95% CI], -0.31 to -2.02; P = 0.008). Compared with HD, HDEX also demonstrated greater improvements from T0 to T2 in twist, an important component of LV myocardial function (estimated difference, 2.48°; 95% CI, 0.30 to 4.65; P = 0.02). Differences in changes from T0 to T2 for cardiac loading and intradialytic hemodynamics did not account for the beneficial effects of IDE on LV myocardial mechanics kinetics.
CONCLUSIONS
IDE applied acutely during HD improves regional myocardial mechanics and might warrant consideration in the therapeutic approach for patients on HD.
Identifiants
pubmed: 37071035
doi: 10.1681/ASN.0000000000000149
pii: 00001751-202308000-00015
pmc: PMC10400099
doi:
Banques de données
ClinicalTrials.gov
['NCT04697459']
Types de publication
Randomized Controlled Trial
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1445-1455Informations de copyright
Copyright © 2023 by the American Society of Nephrology.
Références
Bello AK, Okpechi IG, Osman MA, et al. Epidemiology of haemodialysis outcomes. Nat Rev Nephrol. 2022;18(6):378–395. doi: 10.1038/s41581-022-00542-7
doi: 10.1038/s41581-022-00542-7
Go AS, Chertow GM, Fan D, McCulloch CE, Hsu C. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351(13):1296–1305. doi: 10.1056/NEJMoa041031
doi: 10.1056/NEJMoa041031
Foley RN, Parfrey PS, Harnett JD, Kent GM, Murray DC, Barre PE. Impact of hypertension on cardiomyopathy, morbidity and mortality in end-stage renal disease. Kidney Int. 1996;49(5):1379–1385. doi: 10.1038/ki.1996.194
doi: 10.1038/ki.1996.194
Cibulka R, Racek J. Metabolic disorders in patients with chronic kidney failure. Physiol Res. 2007;56(6):697–705. doi: 10.33549/physiolres.931128
doi: 10.33549/physiolres.931128
Plawecki M, Morena M, Kuster N, et al. sST2 as a new biomarker of chronic kidney disease-induced cardiac remodeling: impact on risk prediction. Mediators Inflamm. 2018;2018:3952526. doi: 10.1155/2018/3952526
doi: 10.1155/2018/3952526
Fraser SDS, Roderick PJ, May CR, et al. The burden of comorbidity in people with chronic kidney disease stage 3: a cohort study. BMC Nephrol. 2015;16(1):193. doi: 10.1186/s12882-015-0189-z
doi: 10.1186/s12882-015-0189-z
Wanner C, Amann K, Shoji T. The heart and vascular system in dialysis. Lancet. 2016;388(10041):276–284. doi: 10.1016/s0140-6736(16)30508-6
doi: 10.1016/s0140-6736(16)30508-6
McIntyre CW. Effects of hemodialysis on cardiac function. Kidney Int. 2009;76(4):371–375. doi: 10.1038/ki.2009.207
doi: 10.1038/ki.2009.207
McGuire S, Horton EJ, Renshaw D, Jimenez A, Krishnan N, McGregor G. Hemodynamic instability during dialysis: the potential role of intradialytic exercise. Biomed Res Int. 2018;2018:8276912. doi: 10.1155/2018/8276912
doi: 10.1155/2018/8276912
Dasselaar JJ, Slart RHJA, Knip M, et al. Haemodialysis is associated with a pronounced fall in myocardial perfusion. Nephrol Dial Transplant. 2008;24(2):604–610. doi: 10.1093/ndt/gfn501
doi: 10.1093/ndt/gfn501
Loutradis C, Sarafidis PA, Papadopoulos CE, Papagianni A, Zoccali C. The ebb and flow of echocardiographic cardiac function parameters in relationship to hemodialysis treatment in patients with ESRD. J Am Soc Nephrol. 2018;29(5):1372–1381. doi: 10.1681/ASN.2017101102
doi: 10.1681/ASN.2017101102
McIntyre CW, Burton JO, Selby NM, et al. Hemodialysis-induced cardiac dysfunction is associated with an acute reduction in global and segmental myocardial blood flow. Clin J Am Soc Nephrol. 2008;3(1):19–26. doi: 10.2215/CJN.03170707
doi: 10.2215/CJN.03170707
Burton JO, Jefferies HJ, Selby NM, McIntyre CW. Hemodialysis-induced cardiac injury: determinants and associated outcomes. Clin J Am Soc Nephrol. 2009;4(5):914–920. doi: 10.2215/CJN.03900808
doi: 10.2215/CJN.03900808
Kanbay M, Ertuglu LA, Afsar B, et al. An update review of intradialytic hypotension: concept, risk factors, clinical implications and management. Clin Kidney J. 2020;13(6):981–993. doi: 10.1093/ckj/sfaa078
doi: 10.1093/ckj/sfaa078
Penny JD, Salerno FR, Brar R, et al. Intradialytic exercise preconditioning: an exploratory study on the effect on myocardial stunning. Nephrol Dial Transplant. 2019;34(11):1917–1923. doi: 10.1093/ndt/gfy376
doi: 10.1093/ndt/gfy376
McGuire S, Horton EJ, Renshaw D, et al. Cardiac stunning during haemodialysis: the therapeutic effect of intra-dialytic exercise. Clin Kidney J. 2019;14(5):1335–1344. doi: 10.1093/ckj/sfz159
doi: 10.1093/ckj/sfz159
Sengupta PP, Tajik AJ, Chandrasekaran K, Khandheria BK. Twist mechanics of the left ventricle. JACC Cardiovasc Imaging. 2008;1(3):366–376. doi: 10.1016/j.jcmg.2008.02.006
doi: 10.1016/j.jcmg.2008.02.006
Borg G. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14(5):377–381. doi: 10.1249/00005768-198205000-00012
doi: 10.1249/00005768-198205000-00012
Van Dalen BM, Vletter WB, Soliman OII, ten Cate FJ, Geleijnse ML. Importance of transducer position in the assessment of apical rotation by speckle tracking echocardiography. J Am Soc Echocardiogr. 2008;21(8):895–898. doi: 10.1016/j.echo.2008.02.001
doi: 10.1016/j.echo.2008.02.001
Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28(1):1–39.e14. doi: 10.1016/j.echo.2014.10.003
doi: 10.1016/j.echo.2014.10.003
Nagueh SF, Smiseth OA, Appleton CP, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2016;17(12):1321–1360. doi: 10.1093/ehjci/jew082
doi: 10.1093/ehjci/jew082
Jamal F, Strotmann J, Weidemann F, et al. Noninvasive quantification of the contractile reserve of stunned myocardium by ultrasonic strain rate and strain. Circulation. 2001;104(9):1059–1065. doi: 10.1161/hc3501.093818
doi: 10.1161/hc3501.093818
Doucende G, Schuster I, Rupp T, et al. Kinetics of left ventricular strains and torsion during incremental exercise in healthy subjects: the key role of torsional mechanics for systolic-diastolic coupling. Circ Cardiovasc Imaging. 2010;3(5):586–594. doi: 10.1161/circimaging.110.943522
doi: 10.1161/circimaging.110.943522
Maufrais C, Schuster I, Doucende G, et al. Endurance training minimizes age-related changes of left ventricular twist-untwist mechanics. J Am Soc Echocardiogr. 2014;27(11):1208–1215. doi: 10.1016/j.echo.2014.07.007
doi: 10.1016/j.echo.2014.07.007
Wang J, Khoury DS, Yue Y, Torre-Amione G, Nagueh SF. Left ventricular untwisting rate by speckle tracking echocardiography. Circulation. 2007;116(22):2580–2586. doi: 10.1161/circulationaha.107.706770
doi: 10.1161/circulationaha.107.706770
Vinet A, Nottin S, Lecoq AM, Guenon P, Obert P. Reproducibility of cardiac output measurements by Doppler echocardiography in prepubertal children and adults. Int J Sports Med. 2001;22(6):437–441. doi: 10.1055/s-2001-16241
doi: 10.1055/s-2001-16241
Stefánsson BV, Brunelli SM, Cabrera C, et al. Intradialytic hypotension and risk of cardiovascular disease. Clin J Am Soc Nephrol. 2014;9(12):2124–2132. doi: 10.2215/CJN.02680314
doi: 10.2215/CJN.02680314
Buchanan C, Mohammed A, Cox E, et al. Intradialytic cardiac magnetic resonance imaging to assess cardiovascular responses in a short-term trial of hemodiafiltration and hemodialysis. J Am Soc Nephrol. 2017;28(4):1269–1277. doi: 10.1681/ASN.2016060686
doi: 10.1681/ASN.2016060686
Amundsen BH, Helle-Valle T, Edvardsen T, et al. Noninvasive myocardial strain measurement by speckle tracking echocardiography. J Am Coll Cardiol. 2006;47(4):789–793. doi: 10.1016/j.jacc.2005.10.040
doi: 10.1016/j.jacc.2005.10.040
Helle-Valle T, Crosby J, Edvardsen T, et al. New noninvasive method for assessment of left ventricular rotation. Circulation. 2005;112(20):3149–3156. doi: 10.1161/circulationaha.104.531558
doi: 10.1161/circulationaha.104.531558
Choi JO, Shin DH, Cho SW, et al. Effect of preload on left ventricular longitudinal strain by 2D speckle tracking. Echocardiography. 2008;25(8):873–879. doi: 10.1111/j.1540-8175.2008.00707.x
doi: 10.1111/j.1540-8175.2008.00707.x
Ahn HS, Kim YK, Song HC, et al. The impact of preload on 3-dimensional deformation parameters: principal strain, twist and torsion. Cardiovasc Ultrasound. 2017;15(1):22. doi: 10.1186/s12947-017-0111-x
doi: 10.1186/s12947-017-0111-x
Guler HS, Tulunay Kaya C, Kumru G, et al. Acute stunning effect of hemodialysis on myocardial performance: a three-dimensional speckle tracking echocardiographic study. Artif Organs. 2020;44(10):1081–1089. doi: 10.1111/aor.13698
doi: 10.1111/aor.13698
Yip A, Naicker S, Peters F, et al. Left ventricular twist before and after haemodialysis: an analysis using speckle-tracking echocardiography. Cardiovasc J Afr. 2018;29(4):231–236. doi: 10.5830/cvja-2018-019
doi: 10.5830/cvja-2018-019
Wu BT, Tsai-Pai MA, Hsu HY, Lin PS, Lin CH, Chen YT. Effect of preload reduction by hemodialysis on left ventricular mechanical parameters by three-dimensional speckle tracking echocardiography. Acta Cardiol Sin. 2012;28:25–33. https://www.semanticscholar.org/paper/Effect-of-Preload-Reduction-by-Hemodialysis-on-Left-Wu-Tsai-Pai/ae7da983097066139fcbd2c83b4abc578c5c7de0
Park SJ, Nishimura RA, Borlaug BA, Sorajja P, Oh JK. The effect of loading alterations on left ventricular torsion: a simultaneous catheterization and two-dimensional speckle tracking echocardiographic study. Eur J Echocardiogr. 2010;11(9):770–777. doi: 10.1093/ejechocard/jeq064
doi: 10.1093/ejechocard/jeq064
Ferferieva V, Van den Bergh A, Claus P, et al. The relative value of strain and strain rate for defining intrinsic myocardial function. Am J Physiol Heart Circ Physiol. 2012;302(1):H188–H195. doi: 10.1152/ajpheart.00429.2011
doi: 10.1152/ajpheart.00429.2011
Schlangen J, Petko C, Hansen JH, et al. Two-Dimensional global longitudinal strain rate is a preload independent index of systemic right ventricular contractility in hypoplastic left heart syndrome patients after fontan operation. Circ Cardiovasc Imaging. 2014;7(6):880–886. doi: 10.1161/circimaging.114.002110
doi: 10.1161/circimaging.114.002110
Burns AT, Gerche AL, Prior DL, MacIsaac AI. Left ventricular torsion parameters are affected by acute changes in load: CME. Echocardiography. 2010;27(4):407–414. doi: 10.1111/j.1540-8175.2009.01037.x
doi: 10.1111/j.1540-8175.2009.01037.x
Voigt JU, Exner B, Schmiedehausen K, et al. Strain-rate imaging during dobutamine stress echocardiography provides objective evidence of inducible ischemia. Circulation. 2003;107(16):2120–2126. doi: 10.1161/01.cir.0000065249.69988.aa
doi: 10.1161/01.cir.0000065249.69988.aa
Sengupta PP, Korinek J, Belohlavek M, et al. Left ventricular structure and function. J Am Coll Cardiol. 2006;48(10):1988–2001. doi: 10.1016/j.jacc.2006.08.030
doi: 10.1016/j.jacc.2006.08.030
Algranati D, Kassab GS, Lanir Y. Why is the subendocardium more vulnerable to ischemia? A new paradigm. Am J Physiol Heart Circ Physiol. 2011;300(3):H1090–H1100. doi: 10.1152/ajpheart.00473.2010
doi: 10.1152/ajpheart.00473.2010
Toyota E, Ogasawara Y, Hiramatsu O, et al. Dynamics of flow velocities in endocardial and epicardial coronary arterioles. Am J Physiol Heart Circ Physiol. 2005;288(4):H1598–H1603. doi: 10.1152/ajpheart.01103.2003
doi: 10.1152/ajpheart.01103.2003
Thijssen DHJ, Redington A, George KP, Hopman MTE, Jones H. Association of exercise preconditioning with immediate cardioprotection: a review. JAMA Cardiol. 2018;3(2):169. doi: 10.1001/jamacardio.2017.4495
doi: 10.1001/jamacardio.2017.4495
Vaisman S, Kensey K, Cho YI. Effect of hemodialysis on whole blood viscosity. Int J Artif Organs. 2009;32(6):329–335. doi: 10.1177/039139880903200603
doi: 10.1177/039139880903200603
Medvedofsky D, Maffessanti F, Weinert L, et al. 2D and 3D echocardiography-derived indices of left ventricular function and shape. JACC Cardiovasc Imaging. 2018;11(11):1569–1579. doi: 10.1016/j.jcmg.2017.08.023
doi: 10.1016/j.jcmg.2017.08.023
Biering-Sorensen T, Biering-Sørensen SR, Olsen FJ, et al. Global longitudinal strain by echocardiography predicts LongTerm risk of cardiovascular morbidity and mortality in a low risk general population: the copenhagen city heart study. J Am Coll Cardiol. 2016;67(13):1584. doi: 10.1016/s0735-1097(16)31585-6
doi: 10.1016/s0735-1097(16)31585-6
Liu YW, Su CT, Sung JM, et al. Association of left ventricular longitudinal strain with mortality among stable hemodialysis patients with preserved left ventricular ejection fraction. Clin J Am Soc Nephrol. 2013;8(9):1564–1574. doi: 10.2215/CJN.10671012
doi: 10.2215/CJN.10671012