Parfrey P S, Harnett J D, Barre P E
Division of Nephrology, Health Sciences Centre, St. John's, Newfoundland, Canada.
J Am Soc Nephrol. 1991 Jul;2(1):2-12. doi: 10.1681/ASN.V212.
Among dialysis patients, only 23% have a normal echocardiogram, about 10% have recurrent or chronic congestive heart failure, and 17% have asymptomatic ischemic heart disease. The predisposing factors for congestive heart failure are dilated cardiomyopathy, hypertrophic hyperkinetic disease, and ischemic heart disease. Dilated cardiomyopathy, a disorder of systolic function, includes among its risk factors age, hyperparathyroidism, and smoking. Hypertrophic disease results in diastolic dysfunction, and its predictors include age, hypertension, aluminum accumulation, anemia, and, perhaps, hyperparathyroidism. Ischemic heart disease is due to the presence of coronary artery disease and also to nonatherosclerotic disease caused by the reduction in coronary vasodilator reserve and altered myocardial oxygen delivery and use. The clinical outcome of congestive heart failure is comparable to that of nonrenal patients with medically refractory heart failure. Left ventricular hypertrophy is an important independent determinant of survival. A subset have hyperkinetic disease with severe hypertrophy and have a bad survival, as low as 43% have a 2-yr survival after the first admission to hospital with cardiac failure. The prognosis for those with dilated cardiomyopathy is less severe but is worse than those with normal echocardiogram. The survival of patients with symptomatic ischemic heart disease was little different from that of patients without symptoms, suggesting that the underlying cardiomyopathies had an adverse impact on survival independent of ischemic disease. Much research needs to be undertaken on the risk factors, natural history, and therapy of the various types of cardiac disease prevalent in dialysis patients.
在透析患者中，只有23%的人超声心动图正常，约10%的人有复发性或慢性充血性心力衰竭，17%的人有无症状性缺血性心脏病。充血性心力衰竭的诱发因素包括扩张型心肌病、肥厚性高动力疾病和缺血性心脏病。扩张型心肌病是一种收缩功能障碍性疾病，其危险因素包括年龄、甲状旁腺功能亢进和吸烟。肥厚性疾病会导致舒张功能障碍，其预测因素包括年龄、高血压、铝蓄积、贫血，可能还有甲状旁腺功能亢进。缺血性心脏病是由于冠状动脉疾病的存在，也由于冠状动脉血管扩张储备减少以及心肌氧输送和利用改变所导致的非动脉粥样硬化性疾病。充血性心力衰竭的临床结局与非肾性难治性心力衰竭患者相当。左心室肥厚是生存的一个重要独立决定因素。一部分患者有严重肥厚的高动力疾病，生存情况较差，首次因心力衰竭入院后2年生存率低至43%。扩张型心肌病患者的预后虽不那么严重，但比超声心动图正常的患者要差。有症状的缺血性心脏病患者的生存率与无症状患者的生存率差别不大，这表明潜在的心肌病对生存有独立于缺血性疾病的不利影响。对于透析患者中普遍存在的各种类型心脏病的危险因素、自然病史和治疗，还有很多研究需要开展。
