Lin Yao-Ping, Chen Chen-Huan, Yu Wen-Chung, Hsu Tsei-Lieh, Ding Philip Yu-An, Yang Wu-Chang
Department of Medicine, Taipei Veterans General Hospital and Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China.
Kidney Int. 2002 Nov;62(5):1828-38. doi: 10.1046/j.1523-1755.2002.00610.x.
It remains uncertain whether the hemodynamic parameters are important determinants of left ventricular mass (LVM) in normotensive chronic hemodialysis (NTHD) patients, as has been found in their hypertensive counterparts.
Forty NTHD patients (mean age, 53.7 +/- 14.4 years; male/female, 18/22) without the requirement of antihypertensive drugs for at least six months were studied. Controls were 41 hypertensive hemodialysis patients (HTHD) and 46 normotensive subjects with normal renal function (NTNR). The influence of anthropometrics, cardiovascular structure and function, and volume status on LVM (by two-dimensional echocardiography) was analyzed by steps of multiple linear regression.
As compared with the NTNR and NTHD group, the HTHD group had obvious pressure and volume/flow overload, and greater LV wall thickness, chamber size and mass. In contrast, NTHD subjects had similar blood pressure, large artery function, LV chamber size and stroke volume as the NTNR subjects. However, the NTHD patients still had greater wall thickness and LVM, along with greater cardiac output, lower total peripheral resistance and lower end-systolic meridional stress to volume ratio (ESSV) than the NTNR group. LVM in the NTHD group was significantly positively related to averaged systolic blood pressure (SBPavg), body surface area, extracellular fluid (ECF), carotid intima-media thickness (IMT), aortic pulse wave velocity (PWV), and negatively related to ESSV and Kt/V. The independent significant noncardiac structural determinants of LVM in NTHD subjects were ESSV, SBPavg, PWV and SV (model r2 = 0.617, P < 0.001).
The NTHD patients, without significant pressure and volume overload, still had increased LVM that was partially explained by the persistent flow overload and subclinical LV dysfunction.
对于血压正常的慢性血液透析（NTHD）患者，血流动力学参数是否如高血压患者那样是左心室质量（LVM）的重要决定因素仍不确定。
对40例至少六个月未使用抗高血压药物的NTHD患者（平均年龄53.7±14.4岁；男/女18/22）进行研究。对照组为41例高血压血液透析患者（HTHD）和46例肾功能正常的血压正常受试者（NTNR）。通过多元线性回归步骤分析人体测量学、心血管结构和功能以及容量状态对LVM（通过二维超声心动图测量）的影响。
与NTNR组和NTHD组相比，HTHD组存在明显的压力和容量/流量超负荷，左心室壁厚度、腔室大小和质量更大。相比之下，NTHD受试者的血压、大动脉功能、左心室腔室大小和每搏输出量与NTNR受试者相似。然而，NTHD患者的壁厚度和LVM仍然更大，与NTNR组相比，心输出量更高，总外周阻力更低，收缩末期子午线应力与容量比（ESSV）更低。NTHD组的LVM与平均收缩压（SBPavg）、体表面积、细胞外液（ECF）、颈动脉内膜中层厚度（IMT）、主动脉脉搏波速度（PWV）呈显著正相关，与ESSV和Kt/V呈负相关。NTHD受试者LVM的独立显著非心脏结构决定因素为ESSV、SBPavg、PWV和SV（模型r2 = 0.617，P < 0.001）。
无明显压力和容量超负荷的NTHD患者，其LVM仍增加，这部分可由持续的流量超负荷和亚临床左心室功能障碍来解释。
