主动脉弓钙化和动脉僵硬度是慢性血液透析患者舒张期左心室功能障碍的独立因素。
Aortic arch calcification and arterial stiffness are independent factors for diastolic left ventricular dysfunction in chronic hemodialysis patients.
作者信息
Fujiu Ayuko, Ogawa Tetsuya, Matsuda Nami, Ando Yoshitaka, Nitta Kosaku
机构信息
Department of Medicine, Kidney Center, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan.
出版信息
Circ J. 2008 Nov;72(11):1768-72. doi: 10.1253/circj.cj-08-0308. Epub 2008 Sep 18.
BACKGROUND
Because cardiovascular disease is the major cause of death in dialysis patients, the correlation between diastolic left ventricular (LV) dysfunction and arterial sclerosis, including thoracic aortic calcification, was studied in chronic hemodialysis (HD) patients.
METHODS AND RESULTS
The enrolled study subjects were 142 (73 men, 69 women) maintenance HD patients. Aortic arch calcification volume (AoACV) was measured by MDCT scan, arterial stiffness was estimated by brachial-ankle pulse wave velocity (PWV) and diastolic LV function was estimated as E/E' by tissue Doppler imaging with cardiac ultrasonography. E/E' correlated significantly with systolic blood pressure (r=0.29, p=0.037), age (r=0.19, p=0.02), LV mass index (r=0.18, p=0.036), dialysis vintage (r=0.19, p=0.037), AoACV (r=0.37, p<0.0001) and PWV (r=0.33, p=0.0002). Multiple regression analysis indicated that AoACV (beta=0.26, p=0.005) and PWV (beta=0.22, p=0.03) were independent determinants of E/E'.
CONCLUSION
Diastolic LV dysfunction may be induced by increased vascular calcification and reduced arterial stiffness in chronic HD patients.
背景
由于心血管疾病是透析患者的主要死因，因此对慢性血液透析（HD）患者舒张期左心室（LV）功能障碍与动脉粥样硬化（包括胸主动脉钙化）之间的相关性进行了研究。
方法与结果
纳入的研究对象为142例维持性HD患者（73例男性，69例女性）。通过MDCT扫描测量主动脉弓钙化体积（AoACV），通过肱踝脉搏波速度（PWV）评估动脉僵硬度，通过心脏超声心动图组织多普勒成像将舒张期LV功能评估为E/E'。E/E'与收缩压（r=0.29，p=0.037）、年龄（r=0.19，p=0.02）、LV质量指数（r=0.18，p=0.036）、透析龄（r=0.19，p=0.037）、AoACV（r=0.37，p<0.0001）和PWV（r=0.33，p=0.0002）显著相关。多元回归分析表明，AoACV（β=0.26，p=0.005）和PWV（β=0.22，p=0.03）是E/E'的独立决定因素。
结论
慢性HD患者舒张期LV功能障碍可能由血管钙化增加和动脉僵硬度降低引起。
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