Cardiac Work Demands and Left Ventricular Function in End-Stage Renal Disease

Publisher Website
Google Scholar
Abstract
Cardiac hemodynamics were assessed by right and left heart catheterizations in 9 patients on hemodialysis. Results showed increased stroke work index and left ventricular work indices. Left ventricular end-diastolic pressure was elevated in all patients (markedly so in 5) and did not fall with occlusion of arteriovenous communications. Cardiac output was significantly elevated, but fell to normal postocclusion. Myocardial O2 consumption, indirectly assessed by tension time and pressure rate indices, appeared increased. Six patients died: 4 from complications attributed to myocardial failure without infarction, 1 from transplant-related complications and 1 from bacterial meningitis. Five had increased cardiac weights at autopsy, but none showed infarction. Increased cardiac work was apparently present in chronic renal failure. Myocardial mass increases resulted in increased myocardial O2 demand; the increased O2 requirements might not be met because of reduced erythrocyte mass. Persistance of pressure-volume overload and severe anemia were conducive to myocardial failure.