Cardioprotective Effect of Acute Intradialytic Exercise: A Comprehensive Speckle-Tracking Echocardiography Analysis

Background 

Hemodialysis induces left ventricular transient myocardial dysfunction. A complex interplay between linear deformations and torsional mechanics underlies left ventricular myocardial performance. Although intradialytic exercise induces favorable effects on central hemodynamics, its effect on myocardial mechanics has never been comprehensively documented.

Methods 

To evaluate the effects of intradialytic exercise on left ventricular myocardial mechanics, assessed by speckle-tracking echocardiography, we conducted a prospective, open-label, two-center randomized crossover trial. We enrolled 60 individuals with end-stage kidney disease receiving hemodialysis, who were assigned to participate in two sessions performed in a randomized order: standard hemodialysis (HD) and hemodialysis incorporating 30 minutes of aerobic exercise (HDEX). We measured global longitudinal strain at baseline (T0), 90 minutes after hemodialysis onset (T1), and 30 minutes before ending hemodialysis (T2). At T0 and T2, we also measured circumferential strain and peak twist, calculated as the net difference between apical and basal rotations. Central hemodynamic data (blood pressure, cardiac output) also were collected.

Results 

The decline in global longitudinal strain observed over the hemodialysis 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 left ventricular 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 intradialytic exercise on left ventricular myocardial mechanics kinetics.

Conclusions 

Intradialytic exercise applied acutely during hemodialysis improves regional myocardial mechanics and might warrant consideration in the therapeutic approach for patients on hemodialysis.

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