Nitta Kosaku, Akiba Takashi, Uchida Keiko, Otsubo Shigeru, Otsubo Yuriko, Takei Takashi, Ogawa Tetsuya, Yumura Wako, Kabaya Takashi, Nihei Hiroshi
Department of Medicine, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan.
Hypertens Res. 2004 Jan;27(1):47-52. doi: 10.1291/hypres.27.47.
Left ventricular hypertrophy (LVH) is the most frequent cardiac abnormality in patients with end-stage renal disease (ESRD). Recent studies have shown that arterial stiffness is associated with mediacalcinosis in these patients. However, whether arterial stiffness and vascular calcification are associated with the LVH in patients with ESRD has not been well established. Forty-nine patients on chronic hemodialysis participated in this study. 1) To better understand the mechanism underlying the increased incidence of LVH, we studied the relation between LVH and each of arterial wall stiffness, aortic calcification, and numerous clinical parameters in 49 patients on chronic hemodialysis. 2) To evaluate the contribution of arterial stiffness and arterial calcification to LVH in hemodialysis patients, we performed the present clinical analysis on 49 patients on chronic hemodialysis. We used an automatic device to measure arterial pulse wave velocity (PWV) as an index of arterial wall stiffness. The aortic calcification index (ACI) was quantified morphometrically by CT scan. The left ventricular mass index (LVMI) was estimated by M-mode echocardiography. To understand the mechanism underlying the increased incidence of LVH, we examined the factors contributing to LVMI in these patients. The correlation between each of the study parameters and LVMI as an indicator of LVH was then examined. The LVMI value was correlated positively with PWV (r=0.439, p=0.0014), systolic blood pressure (r=0.421, p=0.0023), and ACI (r=0.467, p=0.0006). A stepwise linear regression analysis showed that PWV, systolic blood pressure, and ACI were independently associated with LVH in our subjects. These results suggest that LVH is associated with hypertension, increased arterial stiffness, and the extent of vascular calcification in hemodialysis patients, with vascular calcification being the most important contributor to the development of LVH. Alteration of pulsatile dynamics contributes to an increase in left ventricular load and thus is also related to the LVH in these patients. These results suggest that LVH is associated with hypertension, increased arterial stiffness, and the extent of vascular calcification in hemodialysis patients. Vascular calcification, which alters the pulsatile dynamics and thereby contributes to an increase in left ventricular load, is the most important contributor to the development of LVH in patients undergoing hemodialysis.
左心室肥厚（LVH）是终末期肾病（ESRD）患者中最常见的心脏异常。最近的研究表明，动脉僵硬度与这些患者的血管钙化有关。然而，动脉僵硬度和血管钙化是否与ESRD患者的LVH相关尚未明确。49例接受慢性血液透析的患者参与了本研究。1）为了更好地理解LVH发病率增加的潜在机制，我们研究了49例慢性血液透析患者中LVH与动脉壁僵硬度、主动脉钙化以及众多临床参数之间的关系。2）为了评估动脉僵硬度和动脉钙化对血液透析患者LVH的影响，我们对49例慢性血液透析患者进行了本次临床分析。我们使用自动装置测量动脉脉搏波速度（PWV）作为动脉壁僵硬度的指标。通过CT扫描对主动脉钙化指数（ACI）进行形态计量学量化。通过M型超声心动图估计左心室质量指数（LVMI）。为了理解LVH发病率增加的潜在机制，我们检查了这些患者中导致LVMI升高的因素。然后检查了每个研究参数与作为LVH指标的LVMI之间的相关性。LVMI值与PWV（r = 0.439，p = 0.0014）、收缩压（r = 0.421，p = 0.0023）和ACI（r = 0.467，p = 0.0006）呈正相关。逐步线性回归分析表明，PWV、收缩压和ACI在我们的研究对象中与LVH独立相关。这些结果表明，LVH与血液透析患者的高血压、动脉僵硬度增加和血管钙化程度有关，血管钙化是LVH发生发展的最重要因素。搏动动力学的改变导致左心室负荷增加，因此也与这些患者的LVH有关。这些结果表明，LVH与血液透析患者的高血压、动脉僵硬度增加和血管钙化程度有关。血管钙化改变了搏动动力学，从而导致左心室负荷增加，是血液透析患者LVH发生发展的最重要因素。
