Hadj-Abdelkader M, Rozand J Y, Alphonse J C, Guret Cl, Deteix P
Service de néphrologie, unité d'hemodialyse adultes, hôpital Hôtel-Dieu, bd Léon Malfreyt, 63000 Clermont-Ferrand.
Arch Mal Coeur Vaiss. 2003 Jul-Aug;96(7-8):735-7.
The chronic renal failure treated by hemodialysis is associated with a high incidence of prematured cardiovascular diseases, which represents the major causes of morbidity and mortality in hemodialysis patients.
To evaluate the interest of stress echocardiography for the detection of silent myocardial ischaemia in the chronic renal failure treated by hemodialysis.
24 dobutamine stress echocardiography have been achieved in to patients having an average old of 61 +/- 11 years, 15 men and 3 women, with an average dialysis duration of 55 +/- 27 months. Only asymptomatic patients and those presenting an anomaly during the systematic annual echocardiography supervision have been included in this retrospective work. All echocardiography enregistrements have been achieved in the same center and by the same and experimented cardiologist.
75% of patients had an arterial hypertension antecedents, 65% were smokers, 50% had a dyslipidemia, 38% presented an arteriopathy of the inferior members, 30% had diabetes and 22% were obese; 8 (33.5%) stress echocardiographies were negatives. 6 patients have had 2 stress echocardiographies. A coronarography was realized in 16 patients and one of those was strictly normal (6.25% were false positive). 8 patients have had an angioplasty with stent making (1 simple stent, 7 double stent); 2 coronaries by-pass have been done in 2 patients. One patients refused surgery. Insignificant atheroumatous coronary lesions have been detected in 4 patients. In this study, the stress echocardiography enabled to detect a silent myocardial ischaemia in 15/16 patients (93.7%) and to treat 10/15 patients (66.5% including 20% by surgery).
The sensibility of this test must be compared to the thallium scintigraphy coupled with dipyridamole as part of a larger prospective study.
接受血液透析治疗的慢性肾衰竭与心血管疾病过早发生的高发生率相关，这是血液透析患者发病和死亡的主要原因。
评估负荷超声心动图在检测接受血液透析治疗的慢性肾衰竭患者无症状心肌缺血方面的价值。
对平均年龄为61±11岁的患者进行了24次多巴酚丁胺负荷超声心动图检查，其中男性15例，女性3例，平均透析时间为55±27个月。本回顾性研究仅纳入无症状患者以及在系统性年度超声心动图监测期间出现异常的患者。所有超声心动图记录均在同一中心由同一位经验丰富的心脏病专家完成。
75%的患者有高血压病史，65%为吸烟者，50%有血脂异常，38%有下肢动脉病变，30%患有糖尿病，22%肥胖；8例（33.5%）负荷超声心动图检查结果为阴性。6例患者进行了2次负荷超声心动图检查。16例患者进行了冠状动脉造影，其中1例结果完全正常（假阳性率为6.25%）。8例患者进行了支架置入血管成形术（1例单支架，7例双支架）；2例患者进行了冠状动脉搭桥术。1例患者拒绝手术。4例患者检测到无明显意义的动脉粥样硬化性冠状动脉病变。在本研究中，负荷超声心动图能够在15/16例患者（93.7%）中检测到无症状心肌缺血，并对10/15例患者（66.5%，包括20%通过手术治疗）进行了治疗。
作为一项更大规模前瞻性研究的一部分，必须将该检查的敏感性与双嘧达莫负荷铊闪烁显像进行比较。
