Duran Mustafa, Unal Aydin, Inanc Mehmet Tugrul, Kocyigit Ismail, Oguz Fatih, Ocak Ayse, Ozdogru İbrahim, Kasapkara Ahmet, Karakaya Ekrem, Oymak Oktay
Department of Cardiology, Etlik Ihtisas Research and Education Hospital, Ankara, Turkey.
Hemodial Int. 2011 Jul;15(3):334-40. doi: 10.1111/j.1542-4758.2011.00549.x. Epub 2011 Apr 20.
We aimed to evaluate the long-term effect of hemodialysis (HD) treatment on left and right ventricular (LV and RV) functions in patients with end-stage renal disease. The study population consisted of 22 patients with newly diagnosed end-stage renal disease. Before an arteriovenous fistula was surgically created for HD, the patients were evaluated by echocardiography for systolic and diastolic functions. After the first HD session (mean 24.22 ± 2.14 months), the second echocardiographic evaluations were performed. Left ventricular and RV functions before and after long-term HD treatment were compared. The mean age was 55 ± 13 years and 10 (45%) of the patients were female. After long-term HD treatment, the isovolumic relaxation time was significantly decreased; however, the peak early (E) and late (A) diastolic mitral inflow velocities, E/A ratio, and deceleration time of E wave were not significantly different from the baseline measurements. Also, there was no significantly change in the early diastolic velocity (Ea) of the lateral mitral anulus and the E/Ea ratio. Pulmonary vein peak diastolic velocity, peak atrial reversal velocity, and peak atrial reversal velocity duration remained almost unchanged even though the pulmonary vein peak systolic velocity and the pulmonary vein peak systolic velocity/pulmonary vein peak diastolic velocity ratio were significantly lower after long-term HD treatment. In addition, LV systolic functions, LV diameters, LV mass index, left atrium size, and RV diastolic functions were not statistically different after long-term HD treatment. The myocardium is exposed to hemodynamic, metabolic, and neuro-humoral abnormalities during HD treatment; however, the long-term effects of HD on ventricular functions are not clearly known. The present study showed that the long-term effects of HD on LV and RV functions were insignificant in patients with end-stage renal disease. We have demonstrated that the LV and RV functions did not change significantly after long-term HD treatment. We suggest that this result may be due to regulated blood pressure levels of the patients, treatment of anemia and other metabolic disorders during the HD period and the prevention of weight gain and hypervolemia.
我们旨在评估血液透析(HD)治疗对终末期肾病患者左、右心室(LV和RV)功能的长期影响。研究人群包括22例新诊断的终末期肾病患者。在为进行HD手术建立动静脉内瘘之前,通过超声心动图对患者的收缩和舒张功能进行评估。在第一次HD治疗后(平均24.22±2.14个月),进行第二次超声心动图评估。比较长期HD治疗前后的左心室和RV功能。平均年龄为55±13岁,10名(45%)患者为女性。长期HD治疗后,等容舒张时间显著缩短;然而,舒张期二尖瓣血流早期(E)和晚期(A)峰值速度、E/A比值以及E波减速时间与基线测量值相比无显著差异。此外,二尖瓣环外侧舒张早期速度(Ea)和E/Ea比值也无显著变化。尽管长期HD治疗后肺静脉收缩期峰值速度和肺静脉收缩期峰值速度/肺静脉舒张期峰值速度比值显著降低,但肺静脉舒张期峰值速度、心房逆向峰值速度和心房逆向峰值速度持续时间几乎保持不变。此外,长期HD治疗后左心室收缩功能、左心室直径、左心室质量指数、左心房大小和右心室舒张功能无统计学差异。HD治疗期间心肌会受到血流动力学、代谢和神经体液异常的影响;然而,HD对心室功能的长期影响尚不清楚。本研究表明,HD对终末期肾病患者左心室和右心室功能的长期影响不显著。我们已经证明,长期HD治疗后左心室和右心室功能没有显著变化。我们认为,这一结果可能是由于患者血压水平得到控制、HD期间贫血和其他代谢紊乱得到治疗以及体重增加和血容量过多得到预防。