Journal of Echocardiography

, Volume 17, Issue 1, pp 35–43 | Cite as

Echocardiography-based pressure–volume loop assessment in the evaluation for the effects of indoxyl sulfate on cardiovascular function

  • Masaru ObokataEmail author
  • Koji Kurosawa
  • Hideki Ishida
  • Kyoko Ito
  • Tetsuya Ogawa
  • Yoshitaka Ando
  • Masahiko Kurabayashi
  • Kazuaki Negishi
Original Investigation



Indoxyl sulfate (IS), a uremic toxin, has been reported to have hypertrophic effects on the heart. Previous studies, however, have shown no association between elevated IS levels and cardiovascular outcomes in hemodialysis patients. We hypothesized that, despite left ventricular (LV) hypertrophy, myocardial contractility and ventricular–arterial coupling would remain preserved, and that this would explain the reason for the absence of prognostic impact of IS.


We evaluated the association of IS with LV structure, contractility, vascular function, and mechanical efficiency (ventricular–arterial coupling and stroke work/pressure volume area) in 154 patients on hemodialysis, using echocardiography-based pressure–volume loop assessment.


As expected, subjects in the high IS group (IS ≥ 33.8 μg/mL) had greater LV mass index and end-diastolic volume index compared to subjects in the low IS group (IS < 33.8 μg/mL). These differences remained significant after adjusting for age, sex, body mass index, diabetic nephropathy, duration of hemodialysis, and NT-proBNP levels, suggesting a potential role of elevated IS levels in LV remodeling. However, no differences in LV contractility (preload recruitable stroke work, peak power index, and systolic mitral annular velocity) and mechanical efficiency (ventricular–arterial coupling and stroke work/pressure volume area) were observed between the groups.


Deleterious effects of IS on LV remodeling are not accompanied by impaired LV contractility or mechanical efficiency, which could contribute to the absence of cardiovascular prognostic impact observed in previous studies performed on hemodialysis patients.


Cardiac function Efficiency Hemodialysis Remodeling Uremic toxin 


Compliance with ethical standards

Conflict of interest

Dr. Obokata received research funding from Kureha Corporation, Tokyo, Japan. The sponsor was not involved in the study design, data collection, analysis and interpretation, and preparation of manuscript. Dr. Negishi was supported by an award from the Select Foundation, which has no role in the preparation of this manuscript. Drs. Kurosawa, Ishida, Ito, Ogawa, Ando, and Kurabayashi declare that they have no conflict of interest.

Ethical approval

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later revisions.

Informed consent

Informed consent was obtained from all patients for being included in the study.


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Copyright information

© Japanese Society of Echocardiography 2018

Authors and Affiliations

  • Masaru Obokata
    • 1
    Email author
  • Koji Kurosawa
    • 1
  • Hideki Ishida
    • 3
  • Kyoko Ito
    • 3
    • 4
  • Tetsuya Ogawa
    • 3
    • 5
  • Yoshitaka Ando
    • 3
  • Masahiko Kurabayashi
    • 1
  • Kazuaki Negishi
    • 1
    • 2
  1. 1.Department of Cardiovascular MedicineGunma University Graduate School of MedicineMaebashiJapan
  2. 2.Menzies Research Institute TasmaniaHobartAustralia
  3. 3.Hidaka HospitalTakasakiJapan
  4. 4.Department of NephrologyHeisei-Hidaka ClinicTakasakiJapan
  5. 5.Department of MedicineTokyo Women’s Medical University Medical Center EastTokyoJapan

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