Atalay Semra, Ekim Mesiha, Tutar H Ercan, Koçak Gülendam, Bakkaloğlu Sevcan, Tümer Necmiye
Department of Pediatric Cardiology, Ankara University Medical School, Hosdere Cad. 195/3, 06550 Cankaya, Ankara, Turkey.
Pediatr Int. 2002 Feb;44(1):18-23. doi: 10.1046/j.1442-200x.2002.01510.x.
Cardiovascular complications are the most frequent cause of death in patients with end-stage renal failure (ESRF). We aimed to investigate systolic and diastolic functions in children with ESRF.
Thirty-nine children with ESRF (17 on continuous ambulatory peritoneal dialysis (CAPD), eight on hemodialysis and 14 on predialysis) were examined to assess systolic and diastolic functions by echocardiography and ultrasound Doppler. Left ventricular systolic and diastolic functions were measured both in patients and age-matched healthy controls (n = 20) and the indices of cardiac performance were compared.
Increased left ventricular mass index (LVMI) and decreased volume/mass ratio with normal systolic left ventricular function was found in patients, as compared with controls. Left ventricular diastolic dysfunction was observed in dialysis patients. In most of these patients, left ventricular isovolumic relaxation time was prolonged, except in CAPD patients. The peak of late diastolic flow (A) velocities were increased with a reduction of the early diastolic flow velocity (E)--the E/A ratio. The E velocities were unchanged in all patients as compared with controls. Our data indicated an abnormality of myocardial relaxation in patients with ESRF. We found no relationship between E/A ratio and LVMI. Among three groups of patients, the LVMI and diastolic abnormalities were highest in the hemodialysis group indicative of poor control of hypervolemia and hypertension.
The technique of CAPD has some advantages as a renal replacement therapy for preserving cardiac functions as compared with hemodialysis. However, it must be remembered that patients with hemodialysis have features that effects cardiac status, such as higher volume load and higher afterload (hypertension).
心血管并发症是终末期肾衰竭（ESRF）患者最常见的死亡原因。我们旨在研究ESRF患儿的收缩和舒张功能。
对39例ESRF患儿（17例持续非卧床腹膜透析（CAPD），8例血液透析，14例透析前）进行检查，通过超声心动图和超声多普勒评估收缩和舒张功能。测量患者和年龄匹配的健康对照者（n = 20）的左心室收缩和舒张功能，并比较心脏功能指标。
与对照组相比，患者左心室质量指数（LVMI）增加，容积/质量比降低，左心室收缩功能正常。透析患者出现左心室舒张功能障碍。在大多数这些患者中，左心室等容舒张时间延长，但CAPD患者除外。舒张晚期血流（A）速度峰值增加，舒张早期血流速度（E）降低——E/A比值减小。与对照组相比，所有患者的E速度均无变化。我们的数据表明ESRF患者存在心肌舒张异常。我们发现E/A比值与LVMI之间无相关性。在三组患者中，血液透析组的LVMI和舒张异常最高，表明高血容量和高血压控制不佳。
与血液透析相比，CAPD技术作为一种肾脏替代疗法在保护心脏功能方面具有一些优势。然而，必须记住，血液透析患者具有影响心脏状态的特征，如更高的容量负荷和更高的后负荷（高血压）。
