Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea.
J Am Soc Echocardiogr. 2012 Apr;25(4):411-20. doi: 10.1016/j.echo.2011.11.026. Epub 2011 Dec 22.
The aim of this study was to evaluate whether diastolic dysfunction at the start of dialysis could influence renal and cardiovascular survival rates in 82 patients undergoing peritoneal dialysis.
Diastolic dysfunction was determined using left ventricular hypertrophy, the ratio of early peak transmitral inflow velocity to peak diastolic mitral annular velocity (E/E'), and left atrial volume index (LAVI). Residual renal function (RRF) was measured with 24-hour urine collections at baseline (within 1 month of beginning peritoneal dialysis) and thereafter at 6-month intervals for 2 years. To evaluate the long-term prognostic significance of diastolic dysfunction, the 4-year cardiac event-free survival was also evaluated.
The median slope of RRF decline was -0.07 mL/min/mo/1.73 m(2). Forty-five patients (54.9%) with rapid RRF declines (< -0.07 mL/min/mo/1.73 m(2)) had a higher prevalence of diabetes and eccentric left ventricular hypertrophy, as well as significantly elevated E/E' ratios and LAVIs. There was a close relationship between baseline E/E' ratio (r = -0.221, P = .048), LAVI (r = -0.276, P = .015), and RRF decline rate, and both E/E' > 15 (odds ratio, 3.61; 95% confidence interval, 1.07-12.12) and LAVI > 32 mL/m(2) (odds ratio, 3.54; 95% confidence interval, 1.08-11.58) were significant independent predictors of the loss of RRF. Furthermore, E/E' > 15 also provided additional prognostic value in predicting future cardiac events (hazard ratio, 6.74; 95% confidence interval, 1.07-12.12; P = .023).
Left ventricular diastolic dysfunction may be a significant predictor of rapid decline in RRF and adverse cardiac outcomes in patients starting peritoneal dialysis.
本研究旨在评估开始透析时的舒张功能障碍是否会影响 82 名接受腹膜透析患者的肾脏和心血管生存率。
使用左心室肥厚、早期峰二尖瓣血流速度与舒张期二尖瓣环速度比（E/E'）和左心房容积指数（LAVI）来确定舒张功能障碍。残余肾功能（RRF）通过基线（开始腹膜透析后 1 个月内）和此后 2 年内每 6 个月 24 小时尿液收集来测量。为了评估舒张功能障碍的长期预后意义，还评估了 4 年的心脏无事件生存率。
RRF 下降的中位斜率为-0.07 mL/min/mo/1.73 m(2)。45 名（54.9%）RRF 快速下降（< -0.07 mL/min/mo/1.73 m(2)）的患者糖尿病和偏心性左心室肥厚更为常见，E/E'比值和 LAVI 显著升高。基线 E/E'比值（r = -0.221，P =.048）、LAVI（r = -0.276，P =.015）与 RRF 下降率之间存在密切关系，E/E' > 15（优势比，3.61；95%置信区间，1.07-12.12）和 LAVI > 32 mL/m(2)（优势比，3.54；95%置信区间，1.08-11.58）是 RRF 丧失的独立预测因子。此外，E/E' > 15 还可提供额外的预后价值，以预测未来的心脏事件（危险比，6.74；95%置信区间，1.07-12.12；P =.023）。
左心室舒张功能障碍可能是开始腹膜透析患者 RRF 快速下降和不良心脏结局的重要预测因子。
