Ori Yaacov, Korzets Asher, Katz Menachem, Erman Arie, Weinstein Talia, Malachi Tsipora, Gafter Uzi
Department of Nephrology, Rabin Medical Center, Golda Campus, Hasharon, Israel.
Am J Kidney Dis. 2002 Oct;40(4):745-52. doi: 10.1053/ajkd.2002.35685.
The long-term isolated contribution of hemodialysis arteriovenous access (AVA) to cardiac hemodynamics has not been previously investigated in a prospective manner.
Twelve predialysis patients were studied before and 1 and 3 months after creation of a primary AVA. Evaluation included relevant clinical parameters, echocardiographic studies, and hemodynamic hormones.
After creation of an AVA, there was no change in patient weight, blood pressure or hemoglobin level. Cardiac index increased and systemic vascular resistance decreased. Left ventricular mass (LVM) corrected to height increased from 63.8 +/- 5.5 to 68.9 +/- 4.9 g/m(2.7) at 1 month (P = 0.05) and 72.5 +/- 8.9 g/m(2.7) at 3 months (P < 0.05). This increase in LVM was accounted for mostly by an increase in interventricular septal thickness, whereas left ventricular end-diastolic diameter and posterior wall thickness did not change. The incidence of left ventricular hypertrophy (LVH) increased from 67% at baseline to 83% and 90% at 1 and 3 months, respectively. Left atrial area increased from 17.6 +/- 1.0 cm(2) at baseline to 19.7 +/- 1.3 cm(2) at 1 month (P < 0.01) and 20.2 +/- 1.2 cm(2) at 3 months (P < 0.05). Early diastolic transmitral flow increased from 68.0 +/- 4.2 cm/s at baseline to 85.6 +/- 7.3 and 89.2 +/- 6.5 cm/s at 1 and 3 months, respectively (P < 0.01). Inferior vena cava diameter increased at 1 month and did not change at 3 months. Plasma atrial natriuretic polypeptide levels increased from 268 +/- 35 pg/mL (87 +/- 11 pmol/L) at baseline to 461 +/- 63 pg/mL (150 +/- 20 pmol/L) at 1 month (P < 0.01) and 610 +/- 96 pg/mL (198 +/- 31 pmol/L) at 3 months (P < 0.01). Plasma renin activity and serum aldosterone levels decreased. Plasma angiotensin II, angiotensin-converting enzyme, and endothelin levels did not change.
Creation of a hemodialysis AVA is independently associated with further progression of already existing LVH.
此前尚未以前瞻性方式研究血液透析动静脉通路（AVA）对心脏血流动力学的长期单独影响。
对12例透析前患者在建立原发性AVA之前以及之后1个月和3个月进行了研究。评估包括相关临床参数、超声心动图检查和血流动力学激素。
建立AVA后，患者体重、血压或血红蛋白水平无变化。心脏指数增加，全身血管阻力降低。校正身高后的左心室质量（LVM）在1个月时从63.8±5.5增加至68.9±4.9 g/m(2.7)（P = 0.05），在3个月时增加至72.5±8.9 g/m(2.7)（P < 0.05）。LVM的增加主要是由于室间隔厚度增加，而左心室舒张末期直径和后壁厚度未改变。左心室肥厚（LVH）的发生率从基线时的67%分别增加至1个月时的83%和3个月时的90%。左心房面积从基线时的17.6±1.0 cm²增加至1个月时的19.7±1.3 cm²（P < 0.01）和3个月时的20.2±1.2 cm²（P < 0.05）。舒张早期二尖瓣血流速度从基线时的68.0±4.2 cm/s分别增加至1个月时的85.6±7.3 cm/s和3个月时的89.2±6.5 cm/s（P < 0.01）。下腔静脉直径在1个月时增加，在3个月时未改变。血浆心房利钠多肽水平从基线时的268±35 pg/mL（87±11 pmol/L）增加至1个月时的461±63 pg/mL（150±20 pmol/L）（P < 0.01）和3个月时的610±96 pg/mL（198±31 pmol/L）（P < 0.01）。血浆肾素活性和血清醛固酮水平降低。血浆血管紧张素II、血管紧张素转换酶和内皮素水平未改变。
建立血液透析AVA与已存在的LVH的进一步进展独立相关。
