Sugihara K, Fujimoto S, Motomiya Y, Hashimoto T, Nakamura S, Dohi K
First Department of Internal Medicine, Nara Medical University, Japan.
Clin Nephrol. 2001 Aug;56(2):140-9.
It has been suggested that analyzing the left ventricular long axis motion can result in the sensitive detection of cardiac functional disorders.
To evaluate the usefulness of left ventricular long axis indices in managing patients on maintenance hemodialysis.
Eighteen hemodialysis patients (mean age 51 +/- 10 years) as well as 16 healthy persons (mean age 49 +/- 9 years) were examined. Echocardiograms were recorded, and the plasma concentrations of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) were measured before and after a session of hemodialysis. The following parameters were measured: the left atrial diameter (LAD) and end-diastolic left ventricular diameter (LVDd) from M-mode echocardiograms, the end-diastolic LV volume (LVEDV) and ejection fraction (EF) from 2-D echocardiography, the E/A ratio from transmitral Doppler, the atrial systolic excursion of long axis motion of the mitral ring (ALAM) and maximal lengthening rate of the mitral ring toward the left atrium during the early diastolic phase (MLRe) from LV long axis M-mode echocardiograms.
LAD, LVDd, LVEDV, and ALAM showed a positive correlation with plasma levels of ANP and BNP. EF, the E/A ratio, and MLRe showed a negative correlation with plasma levels of ANP and BNP. Changes in ALAM and plasma levels of ANP during hemodialysis were larger in the subgroup of ALAM < or = 0.55 cm before hemodialysis than in the subgroup of ALAM < 0.55 cm before hemodialysis.
These results indicate that the left ventricular long axis index can detect a disorder of left ventricular diastolic function, and that a hemodialysis patient whose ALAM before hemodialysis is < 0.55 cm is dialyzed with good volume control conditions.
有人提出分析左心室长轴运动可灵敏检测心脏功能紊乱。
评估左心室长轴指标在维持性血液透析患者管理中的作用。
检查了18例血液透析患者（平均年龄51±10岁）以及16名健康人（平均年龄49±9岁）。记录超声心动图，并在一次血液透析前后测量血浆心房利钠肽（ANP）和脑利钠肽（BNP）浓度。测量以下参数：M型超声心动图测得的左心房直径（LAD）和舒张末期左心室直径（LVDd），二维超声心动图测得的舒张末期左心室容积（LVEDV）和射血分数（EF），经二尖瓣多普勒测得的E/A比值，左心室长轴M型超声心动图测得的二尖瓣环长轴运动的心房收缩期偏移（ALAM）以及舒张早期二尖瓣环向左心房的最大延长率（MLRe）。
LAD、LVDd、LVEDV和ALAM与ANP和BNP的血浆水平呈正相关。EF、E/A比值和MLRe与ANP和BNP的血浆水平呈负相关。血液透析前ALAM≤0.55 cm的亚组中，血液透析期间ALAM和ANP血浆水平的变化大于血液透析前ALAM＜0.55 cm的亚组。
这些结果表明左心室长轴指标可检测左心室舒张功能紊乱，且血液透析前ALAM＜0.55 cm的患者在容量控制良好的条件下进行透析。
