Bjällmark Anna, Larsson Matilda, Nowak Jacek, Lind Britta, Hayashi Shirley Yumi, do Nascimento Marcelo Mazza, Riella Miguel C, Seeberger Astrid, Brodin Lars-Åke
Department of Medical Engineering, School of Technology and Health, Royal Institute of Technology (KTH), Alfred Nobels Allé 10, Huddinge, 141 52, Stockholm, Sweden.
Heart Vessels. 2011 May;26(3):289-97. doi: 10.1007/s00380-010-0050-z. Epub 2010 Nov 10.
Cardiovascular disease is the leading cause of death in patients with end-stage renal disease (ESRD). The aim of this study was to investigate the changes in cardiovascular function induced by a single session of hemodialysis (HD) by the analysis of cardiovascular dynamics using wave intensity wall analysis (WIWA) and of systolic and diastolic myocardial function using tissue velocity imaging (TVI). Gray-scale cine loops of the left common carotid artery, conventional echocardiography, and TVI images of the left ventricle were acquired before and after HD in 45 patients (17 women, mean age 54 years) with ESRD. The WIWA indexes, W(1) and preload-adjusted W(1), W(2) and preload-adjusted W(2), and the TVI variables, isovolumic contraction velocity (IVCV), isovolumic contraction time (IVCT), peak systolic velocity (PSV), displacement, isovolumic relaxation velocity (IVRV), isovolumic relaxation time (IVRT), peak early diastolic velocity (E'), and peak late diastolic velocity (A'), were compared before and after HD. The WIWA measurements showed significant increases in W(1) (P < 0.05) and preload-adjusted W(1) (P < 0.01) after HD. W(2) was significantly decreased (P < 0.05) after HD, whereas the change in preload-adjusted W(2) was not significant. Systolic velocities, IVCV (P < 0.001) and PSV (P < 0.01), were increased after HD, whereas the AV-plane displacement was decreased (P < 0.01). For the measured diastolic variables, E' was significantly decreased (P < 0.01) and IVRT was significantly prolonged (P < 0.05), after HD. A few correlations were found between WIWA and TVI variables. The WIWA and TVI measurements indicate that a single session of HD improves systolic function. The load dependency of the diastolic variables seems to be more pronounced than for the systolic variables. Preload-adjusted wave intensity indexes may contribute in the assessment of true LV contractility and relaxation.
心血管疾病是终末期肾病（ESRD）患者的主要死因。本研究的目的是通过使用波强度壁分析（WIWA）分析心血管动力学以及使用组织速度成像（TVI）分析收缩期和舒张期心肌功能，来研究单次血液透析（HD）引起的心血管功能变化。在45例ESRD患者（17名女性，平均年龄54岁）进行HD前后，采集左颈总动脉的灰阶电影环、传统超声心动图以及左心室的TVI图像。比较HD前后的WIWA指标W(1)和预负荷调整后的W(1)、W(2)和预负荷调整后的W(2)，以及TVI变量等容收缩速度（IVCV）、等容收缩时间（IVCT）、收缩期峰值速度（PSV）、位移、等容舒张速度（IVRV）、等容舒张时间（IVRT）、舒张早期峰值速度（E'）和舒张晚期峰值速度（A'）。WIWA测量显示HD后W(1)（P < 0.05）和预负荷调整后的W(1)（P < 0.01）显著增加。HD后W(2)显著降低（P < 0.05），而预负荷调整后的W(2)变化不显著。HD后收缩期速度IVCV（P < 0.001）和PSV（P < 0.01）增加，而房室平面位移降低（P < 0.01）。对于测量的舒张期变量，HD后E'显著降低（P < 0.01），IVRT显著延长（P < 0.05）。在WIWA和TVI变量之间发现了一些相关性。WIWA和TVI测量表明单次HD可改善收缩功能。舒张期变量的负荷依赖性似乎比收缩期变量更明显。预负荷调整后的波强度指标可能有助于评估左心室真正的收缩性和舒张性。
