Toprak Ahmet, Koc Mehmet, Tezcan Hakan, Ozener Ishak Cetin, Akoglu Emel, Oktay Ahmet
Department of Internal Medicine, Marmara University School of Medicine, Tophanelioglu Cad. No: 13/15, Altunizade, 34660 Istanbul, Turkey.
Nephrol Dial Transplant. 2003 Oct;18(10):2128-33. doi: 10.1093/ndt/gfg298.
Changes in left ventricular (LV) geometry are frequent in patients with continuous ambulatory peritoneal dialysis (CAPD). Geometric adaptation of LV to various stimuli was reported to have adverse prognosis. This study aimed to identify independent risk factors, which contribute to the development of LV geometric remodelling in CAPD patients.
The left ventricles of 69 CAPD patients were classified echocardiographically into four different geometric patterns on the basis of LV mass and relative wall thickness. With respect to volume factor, we measured inferior vena cava (IVC) diameter and its decrease on deep inspiration [collapsibility index (CI)] by echocardiography. We modelled a stepwise multiple regression analysis to determine the predictors of LV geometry.
All four geometric models of LV were identified in our group of 69 CAPD patients. Eccentric left ventricular hypertrophy (eLVH) was observed in 32 (46%), concentric LVH (cLVH) in 19 (28%), normal geometry (NG) in 10 (14%) and concentric remodelling (CR) in eight (12%) CAPD patients. Mean IVC index of the eLVH group (10.72 +/- 2.19 mm/m(2)) was significantly higher than corresponding indexes of NG (7.90 +/- 1.54 mm/m(2)), CR (8.51 +/- 1.28 mm/m(2)) and cLVH (8.04 +/- 2.00 mm/m(2)) groups (P < 0.001 for each comparisons). The eLVH group also had significantly lower mean CI value (0.48 +/- 0.11) than CR (0.58 +/- 0.09) and cLVH (0.57 +/- 0.07) groups (ANOVA P = 0.008). Stepwise multiple regression analysis revealed that IVC index, CI and haemoglobin were the independent predictors of LV geometric stratification (R2 = 0.36, P < 0.001).
Hypervolaemia, identified by IVC index and CI, and anaemia contribute independently to LV geometry in CAPD patients. Echocardiography as a non-invasive tool is not only useful to determine LV geometry, but also to assess the volume status of CAPD patients.
持续性非卧床腹膜透析（CAPD）患者左心室（LV）几何形态改变很常见。据报道，LV对各种刺激的几何适应具有不良预后。本研究旨在确定导致CAPD患者LV几何重塑发生的独立危险因素。
根据LV质量和相对壁厚，通过超声心动图将69例CAPD患者的左心室分为四种不同的几何模式。关于容量因素，我们通过超声心动图测量下腔静脉（IVC）直径及其在深吸气时的减小[塌陷指数（CI）]。我们建立了逐步多元回归分析模型来确定LV几何形态的预测因素。
在我们的69例CAPD患者组中识别出了LV的所有四种几何模型。32例（46%）患者观察到偏心性左心室肥厚（eLVH），19例（28%）为同心性LVH（cLVH），10例（14%）为正常几何形态（NG），8例（12%）为同心性重塑（CR）。eLVH组的平均IVC指数（10.72±2.19 mm/m²）显著高于NG组（7.90±1.54 mm/m²）、CR组（8.51±1.28 mm/m²）和cLVH组（8.04±2.00 mm/m²）（每组比较P<0.001）。eLVH组的平均CI值（0.48±0.11）也显著低于CR组（0.58±0.09）和cLVH组（0.57±0.07）（方差分析P = 0.008）。逐步多元回归分析显示，IVC指数、CI和血红蛋白是LV几何分层的独立预测因素（R² = 0.36，P<0.001）。
通过IVC指数和CI识别的高血容量以及贫血独立地影响CAPD患者的LV几何形态。超声心动图作为一种非侵入性工具，不仅有助于确定LV几何形态，还可用于评估CAPD患者的容量状态。
