Galetta Fabio, Cupisti Adamasco, Franzoni Ferdinando, Carpi Angelo, Barsotti Giuliano, Santoro Gino
Department of internal medicine, University of Pisa School of Medicine, Via Roma, 67, 56126 Pisa, Italy.
Biomed Pharmacother. 2006 Feb;60(2):66-70. doi: 10.1016/j.biopha.2005.10.008. Epub 2005 Dec 28.
Evidence exists that left ventricular function is impaired in chronic uremic patients. During hemodialysis (HD) treatment, myocardium undergoes electrolyte, hemodynamic and neuro-humoral stress; however, data about the acute changes on ventricular function are controversial. Aim of the present study was to evaluate the effect of a single hemodialysis session on left ventricular (LV) systolic and diastolic function using pulsed tissue Doppler imaging (TDI) sampled by echocardiography. The study group included 20 uremic patients (17 males, aged 51+/-13 yrs) on maintenance HD, free from clinically overt cardiac dysfunction who underwent echocardiography with pulsed TDI 30 min prior and 30 min after a HD session. TDI was performed by placing the sample volume in the center of the basal lateral segment and the basal interventricular septum in the apical four-chamber view. Myocardial systolic wave (S(m)) and early (E(m)) and atrial (A(m)) diastolic waves were measured. On standard sonography examination, no significant changes in LV systolic function parameters were observed after HD, but the indices for LV diastolic function deteriorated significantly (peak E, 75.4+/-11.2 vs. 58.8+/-12.5 cm/s, P<0.01; E/A ratio, 1.0+/-0.3 vs. 0.8+/-0.2, P<0.01). However, regarding TDI measures following HD, the patients exhibited a lower S(m) peak (septum: 7.6+/-1.1 vs. 5.9+/-0.8 cm/s; lateral wall: 7.7+/-1.7 vs. 6.8+/-1.2 cm/s, P<0.001), a lower E(m) peak (septum: 8.3+/-1.6 vs. 6.3+/-1.7 cm/s; lateral wall: 10.2+/-2.4 vs. 7.1+/-1.9 cm/s, P<0.001), and a reduced E(m)/A(m) ratio (septum: 1.0+/-0.4 vs. 0.7+/-0.2; lateral wall: 1.2+/-0.5 vs. 0.7+/-0.2, P<0.001, respectively), as compared to pre-HD parameters. Of interest, peak E(m), and E(m)/A(m) ratio of the lateral wall were negatively related to ultrafiltration rate (r = -0.60, P<0.05 and -0.69, P<0.01, respectively). Our data indicate that a single hemodialysis session is associated with acute deterioration of diastolic and systolic parameters of myocardial function, as assessed by TDI. These reversible changes could be considered as a cardiac stunning that seems to be related to the ultrafiltration rate and then to the interdialysis weight gain. These findings suggest that low ultrafiltration volume and/or limited interdialytic weight gain are cardioprotective measures in hemodialysis patients.
有证据表明慢性尿毒症患者左心室功能受损。在血液透析（HD）治疗期间，心肌会经历电解质、血流动力学和神经体液应激；然而，关于心室功能急性变化的数据存在争议。本研究的目的是使用超声心动图采样的脉冲组织多普勒成像（TDI）来评估单次血液透析对左心室（LV）收缩和舒张功能的影响。研究组包括20名接受维持性HD的尿毒症患者（17名男性，年龄51±13岁），这些患者无临床明显的心脏功能障碍，在HD治疗前30分钟和治疗后30分钟接受了带有脉冲TDI的超声心动图检查。通过将取样容积置于心尖四腔视图中基底外侧节段和基底室间隔的中心来进行TDI。测量心肌收缩波（S(m)）、早期（E(m)）和心房（A(m)）舒张波。在标准超声检查中，HD后左心室收缩功能参数未见明显变化，但左心室舒张功能指标显著恶化（E峰峰值，75.4±11.2 vs. 58.8±12.5 cm/s，P<0.01；E/A比值，1.0±0.3 vs. 0.8±0.2，P<0.01）。然而，关于HD后的TDI测量，与HD前参数相比，患者的S(m)峰值较低（室间隔：7.6±1.1 vs. 5.9±0.8 cm/s；侧壁：7.7±1.7 vs. 6.8±1.2 cm/s，P<0.001），E(m)峰值较低（室间隔：8.3±1.6 vs. 6.3±1.7 cm/s；侧壁：10.2±2.4 vs. 7.1±1.9 cm/s，P<0.001），E(m)/A(m)比值降低（室间隔：1.0±0.4 vs. 0.7±0.2；侧壁：1.2±0.5 vs. 0.7±0.2，P<0.001）。有趣的是，侧壁的E(m)峰值和E(m)/A(m)比值与超滤率呈负相关（r = -0.60，P<0.05和 -0.69，P<0.01）。我们的数据表明，单次血液透析与心肌功能舒张和收缩参数的急性恶化相关，这通过TDI评估得出。这些可逆性变化可被视为一种心脏顿抑，似乎与超滤率相关，进而与透析间期体重增加有关。这些发现表明，低超滤量和/或有限的透析间期体重增加是血液透析患者的心脏保护措施。
