Lin Chun-Liang, Hsu Po-Yaur, Yang Cheng-Ta, Yang Huan-Yu, Yang Teng-Yao, Huang Wen-Hung, Huang Chiu-Ching
Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan.
Ren Fail. 2003 Mar;25(2):287-95. doi: 10.1081/jdi-120018729.
A recent report demonstrated that the presence of left ventricular hypertrophy was an independent predictor of mortality in patients with coronary artery bypass grafting (CABG) severely depressed left ventricular function. However, the impact of left ventricle (LV) mass index on the renal and patient outcomes in such patients with CABG has previously not been addressed. The present study thus considers this group of patient and uses LV mass index to assess renal and patient outcomes for these patients.
All patients who arrived at the emergency room with severe cardiac dysfunction (EF < 60%), triple vessel disease, and required CABG and LV hypertrophy (LVH) (LV mass index gamma110 g/m2 in women, gamma134 g/m2 in men) were admitted preoperatively to the intensive care unit (ICU) for supportive intervention from January 1, 1998 to January 1, 2001. Of all LVH patients, 44 underwent CABG, and were divided into two groups according to LV mass index.
Of all patients, 72.7% had severe echocardiographic LVH. The echocardiographic data of both dialysis and non-dialysis groups showed no difference with respect to echocardiographic findings. Histories of myocardial infarction were more frequent in the severe LVH group that in the mild LVH group. As for pre-operative systolic blood pressure and diastolic blood pressure, mean systolic and diastolic blood pressure values were significantly lower in the severe LVH group. Ejection fraction was also significantly lower in the severe LVH group than in the mild LVH group. The patients in the severe LVH group were significantly more likely to have received hemodialysis following CABG surgery (62.5% vs. 33.4%, p < 0.05). Mortality was higher in the higher LV mass index group that in the lower LV mass index group (56.2% vs. 25%, p < 0.05). CONCLUSION; Patients with a significantly higher LV mass index usually manifest lower pre-operative blood pressure and poor cardiac function. Consequently, these patients will have a poor renal outcome and higher mortality.
最近的一份报告表明，左心室肥厚的存在是冠状动脉搭桥术（CABG）患者死亡率的独立预测因素，这些患者左心室功能严重受损。然而，左心室（LV）质量指数对这类CABG患者肾脏及患者预后的影响此前尚未得到探讨。因此，本研究针对这组患者，采用LV质量指数来评估这些患者的肾脏及患者预后。
1998年1月1日至2001年1月1日期间，所有因严重心脏功能不全（射血分数<60%）、三支血管病变而抵达急诊室且需要进行CABG及左心室肥厚（LVH）（女性LV质量指数>110 g/m²，男性LV质量指数>134 g/m²）的患者，术前被收入重症监护病房（ICU）进行支持性干预。在所有LVH患者中，44例接受了CABG，并根据LV质量指数分为两组。
所有患者中，72.7%有严重的超声心动图左心室肥厚。透析组和非透析组的超声心动图数据在超声心动图表现方面无差异。严重LVH组心肌梗死病史比轻度LVH组更常见。至于术前收缩压和舒张压，严重LVH组的平均收缩压和舒张压值显著更低。严重LVH组的射血分数也显著低于轻度LVH组。严重LVH组患者在CABG手术后接受血液透析的可能性显著更高（62.5%对33.4%，p<0.05）。LV质量指数较高组的死亡率高于较低组（56.2%对25%，p<0.05）。结论：LV质量指数显著较高的患者通常术前血压较低且心脏功能较差。因此，这些患者肾脏预后较差且死亡率较高。
