维持性血液透析尿毒症患者左心室几何形态与功能的超声心动图评估

[Echocardiographic evaluation of left ventricular geometry and function in maintenance hemodialysis uremic patients].

作者信息

Li Ai-li, Ke Yuan-nan, Zeng Yu-jie, Li Wen-ge, Bian Wei-jing

机构信息

Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China.

出版信息

Zhonghua Xin Xue Guan Bing Za Zhi. 2009 Oct;37(10):913-6.

PMID:20137543

Abstract

OBJECTIVE

To assess left ventricular (LV) geometry, LV diastolic and systolic function in maintenance hemodialysis uremic patients.

METHODS

Forty uremic patients and forty-five normal subjects were included in this study. LV volume, LV mass index (LVMI), relative wall thickness (RWT), LV mass and diastolic volume ratio (LVM/EDV) were measured. Mitral flow E velocity and A velocity ratio, deceleration time, mitral flow E velocity and mitral annulus Ea velocity ratio (E/Ea), pulmonary vein flow S velocity and D velocity ratio, atrial flow reversal velocity of pulmonary vein flow, mitral inflow propagation velocity, left atrium volume (LAV) and pulmonary artery systolic pressure (PASP) were determined for diastolic function evaluation. LV ejection fraction (LVEF) and single volume (SV) were derived from 3D echocardiography, systolic velocity of mitral valve annulus (Sa) by pulse tissue Doppler imaging (TDI) were used to evaluate systolic function. The time to peak systolic velocity (Ts) and early diastole velocity (Td) of LV 12 segments were measured using TDI. The maximal difference of Ts and Td (Ts-Dif and Td-Dif) were calculated to assess LV systolic and diastolic asynchrony.

RESULTS

RWT, LVMI and LVM/EDV were significantly increased in uremic patients. There were 50% concentric, 17.5% eccentric hypertrophy and 17.5%concentric remodeling, respectively in uremic patients. The indices for LV diastolic function (E/Ea, LAV and PASP) were significantly higher in uremic patients than those in control subjects (P < 0.01). About 85% of the diastolic dysfunction in uremic patients presented as impaired relaxation pattern and 32.5% as increased filling pressure. LVEF and SV were similar between uremic patients and control subjects. Sa was significantly lower in uremic group than that in controls (P < 0.05). Ts-Dif was similar between the 2 groups while Td-Dif was significantly higher in uremic patients than control subjects (P < 0.05).

CONCLUSION

LV hypertrophy, LV mass increase and LV diastolic dysfunction were the major characteristic of myocardial injury in uremia patients.

摘要

目的

评估维持性血液透析尿毒症患者的左心室（LV）几何形态、左心室舒张和收缩功能。

方法

本研究纳入40例尿毒症患者和45例正常受试者。测量左心室容积、左心室质量指数（LVMI）、相对室壁厚度（RWT）、左心室质量与舒张末期容积比（LVM/EDV）。测定二尖瓣血流E峰速度与A峰速度比值、减速时间、二尖瓣血流E峰速度与二尖瓣环Ea峰速度比值（E/Ea）、肺静脉血流S峰速度与D峰速度比值、肺静脉血流心房逆向速度、二尖瓣流入血流传播速度、左心房容积（LAV）和肺动脉收缩压（PASP）以评估舒张功能。左心室射血分数（LVEF）和每搏量（SV）由三维超声心动图得出，通过脉冲组织多普勒成像（TDI）测量二尖瓣环收缩期速度（Sa）以评估收缩功能。使用TDI测量左心室12节段的收缩期峰值速度（Ts）和舒张早期速度（Td）。计算Ts和Td的最大差值（Ts-Dif和Td-Dif）以评估左心室收缩和舒张不同步性。

结果

尿毒症患者的RWT、LVMI和LVM/EDV显著升高。尿毒症患者中分别有50%为向心性肥厚、17.5%为离心性肥厚和17.5%为向心性重构。尿毒症患者左心室舒张功能指标（E/Ea、LAV和PASP）显著高于对照组（P<0.01）。尿毒症患者中约85%的舒张功能障碍表现为舒张功能受损模式，32.5%表现为充盈压升高。尿毒症患者和对照组之间的LVEF和SV相似。尿毒症组的Sa显著低于对照组（P<0.05）。两组之间的Ts-Dif相似，而尿毒症患者的Td-Dif显著高于对照组（P<0.05）。