Objectives .– Diastolic dysfunction is the most common entity of heart failure. The purpose of this study is to identify the determinant(s) of severe diastolic dysfunction (defined by a E/e′ ratio > 15 on Tissue Doppler Imaging: TDI), in patients on chronic hemodialysis (HD).

Patients and methods .– Seventy-two patients on chronic HD and preserved LV systolic function were included in the study. LV function was assessed by Doppler echocardiography, left ventricular mass index (LVMI) was estimated by echocardiography using formula of Devereux and Reicheck. Our Patients were divided in two groups based on E/e′ ratio measured by TDI: group I (E/e′ ≤ 15; n = 61) and group II (E/e′ > 15, n = 11).

Results .– No differences were noted between the two groups concerning age, gender, body mass index, proportions of arterial hypertension and diabetes, duration of dialysis, blood pressure and use of drugs.

On echocardiography, there were no significant differences for E/A ratio, deceleration time, and pulse wave velocity between both groups.

However, LVMI was higher in group II (group I = 247 g/m ² , one group II = 419 g/m ² ; P < 0.001), the dilatation of the left atrium was more important in group II ( P = 0.01). On multiple regression analysis, LVMI was the only independent determinant of E/e′ ratio ( P = 0.001).

Conclusion .– Our findings suggest that LVMI is an independent determinant of LV severe diastolic dysfunction in patients on HD.