Drighil Abdenasser, Madias John E, Mathewson James W, El Mosalami Hanane, El Badaoui Nadia, Ramdani Beenyouness, Bennis Ahmed
Department of Cardiology, Ibn Rochd University Hospital, Casablanca, Morocco.
Eur J Echocardiogr. 2008 Jul;9(4):530-5. doi: 10.1093/ejechocard/jen125. Epub 2008 Mar 27.
Conventional echocardiographic (ECHO) parameters of left ventricular (LV) and right ventricular (RV) systolic and diastolic function have been shown to be load-dependent; however, the impact of preload reduction on tissue Doppler (TD) parameters of LV and RV function is incompletely understood. The aim of this study was to examine the effect of acute preload reduction by haemodialysis (HD) on conventional (ECHO) and TD imaging (TDI) indices of systolic and diastolic function of the left and right ventricles.
Seventeen chronically uremic patients (age 31 +/- 10 years), without overt heart disease underwent conventional 2D and Doppler ECHO together with measurement of longitudinal mitral and tricuspid annular motion velocities. Fluid volume removed by HD was 2706 +/- 1047 cm(3). Haemodialysis led to reduction in LV end-diastolic volume (P < 0.0001), end-systolic volume (P < 0.001), peak early (E wave) transmitral flow velocity (P = 0.0001), and the ratio of early to late Doppler velocities of diastolic mitral inflow (P = 0.021). For the LV, early diastolic (E0) TDI velocities and the ratio of early to late TDI diastolic velocities (E0/A0) only on the septal side of the mitral annulus decreased significantly after HD (P = 0.0001 and P = 0.009, respectively). In a subgroup of seven patients who sustained significantly larger fluid volume loses following HD, E0 and the ratio of E0/A0 at the lateral side of mitral annulus also decreased suggesting a greater resistance of the lateral annulus to preload changes. Systolic velocities decreased after HD on both sides of mitral annulus (septal 6.90 +/- 1.10 vs. 5.97 +/- 1.48 cm/s, P = 0.006; lateral 8.68 +/- 2.67 vs. 6.94 +/- 1.52 cm/s, P = 0.011). For the RV, systolic tricuspid annular velocities decreased (13.45 +/- 1.47 vs.11.73 +/- 1.90 cm/s, P = 0.002) together with early diastolic velocities after HD (13.95 +/- 2.90 vs.10.62 +/- 2.45 cm/s, P = 0.0001). Both systolic and early diastolic tricuspid annular velocities correlated directly with fluid removal (P < 0.01).
This study shows that both systolic and diastolic TDI velocities of the LV and RV are preload-dependent. However, the lateral mitral annulus is more resistant to preload changes than either the septal mitral annulus or the lateral tricuspid annulus.
传统超声心动图（ECHO）测量的左心室（LV）和右心室（RV）收缩与舒张功能参数已被证明受负荷影响；然而，前负荷降低对LV和RV功能的组织多普勒（TD）参数的影响尚未完全明确。本研究旨在探讨血液透析（HD）引起的急性前负荷降低对左、右心室收缩和舒张功能的传统（ECHO）及TD成像（TDI）指标的影响。
17例无明显心脏病的慢性尿毒症患者（年龄31±10岁）接受了传统二维和多普勒ECHO检查，并测量了二尖瓣和三尖瓣环的纵向运动速度。HD清除的液体量为2706±1047 cm³。血液透析导致LV舒张末期容积降低（P<0.0001）、收缩末期容积降低（P<0.001）、二尖瓣血流早期峰值（E波）速度降低（P = 0.0001）以及二尖瓣舒张期流入血流早期与晚期多普勒速度之比降低（P = 0.021）。对于LV，HD后仅二尖瓣环间隔侧的舒张早期（E0）TDI速度和舒张期TDI早期与晚期速度之比（E0/A0）显著降低（分别为P = 0.0001和P = 0.009）。在HD后液体丢失量显著更大的7例患者亚组中，二尖瓣环外侧的E0和E0/A0比值也降低，提示外侧瓣环比间隔瓣环或外侧三尖瓣环对前负荷变化的抵抗力更强。HD后二尖瓣环两侧的收缩速度均降低（间隔侧6.90±1.10 vs. 5.97±1.48 cm/s，P = 0.006；外侧8.68±2.67 vs. 6.94±1.52 cm/s，P = 0.011）。对于RV，HD后三尖瓣环收缩速度降低（13.45±1.47 vs.11.73±1.90 cm/s，P = 0.002），同时舒张早期速度降低（13.95±2.90 vs.10.62±2.45 cm/s，P = 0.0001）。三尖瓣环收缩和舒张早期速度均与液体清除量直接相关（P<0.01）。
本研究表明，LV和RV的收缩及舒张TDI速度均依赖于前负荷。然而，二尖瓣环外侧比二尖瓣环间隔侧或三尖瓣环外侧对前负荷变化的抵抗力更强。
