Akkaya Mehmet, Erdoğan Ercan, Sağ Saim, Arı Hasan, Türker Yasin, Yılmaz Mustafa
Bursa Asker Hastanesi, Kardiyoloji Kliniği, Bursa-Turkey.
Anadolu Kardiyol Derg. 2012 Feb;12(1):5-10. doi: 10.5152/akd.2012.002. Epub 2012 Jan 4.
The aim of this study was to evaluate the effects of hemodialysis (HD) on right ventricular echocardiographic parameters in patients with end-stage renal failure (ESRF).
Forty-three uremic patients who underwent echocardiography before and 30 minutes after dialysis included in this prospective observational study. Right ventricular systolic function was evaluated using tricuspid annular plane systolic excursion (TAPSE) by M-mode echocardiography and tricuspid lateral annular systolic velocity (Sa) by tissue Doppler echocardiography whereas diastolic function was evaluated using tricuspid early (E) and late (A) diastolic flow velocities by conventional and tricuspid lateral annular early (Ea) and late (Aa) diastolic velocities by tissue Doppler echocardiography. Myocardial performance index was taken as an indicator of global functions. Paired t test or Wilcoxon test were used for statistical analysis where appropriate.
E decreased significantly (68 ± 13 cm/s and 56 ± 12 cm/s before and after HD, respectively; p<0.0001) but A did not (p=0.797).TAPSE was 1.84 ± 0.34 cm before HD and showed a significant increase to 2.03 ± 0.20 cm after HD (p=0.006). Right ventricular MPI, Sa and Aa did not change significantly by dialysis (p=0.504; p=0.118 and p=0.150 respectively) whereas Ea decreased to 8.8 ± 2.5 cm/s from 11.3 ± 3.4 cm/s (p<0.001). Ea/Aa ratio also decreased significantly to 0.69 ± 0.35 from 0.84 ± 0.44 with HD (p=0.007).
The results of this study indicates that parameters of right ventricular systolic function such as Sa and MPI are independent of preload whereas the conventional and tissue Doppler parameters of right ventricular diastolic function are preload dependent in patients with end-stage renal failure who undergo regular hemodialysis.
本研究旨在评估血液透析（HD）对终末期肾衰竭（ESRF）患者右心室超声心动图参数的影响。
本前瞻性观察性研究纳入了43例在透析前及透析后30分钟接受超声心动图检查的尿毒症患者。采用M型超声心动图测量三尖瓣环平面收缩期位移（TAPSE）及组织多普勒超声心动图测量三尖瓣侧壁环收缩期速度（Sa）来评估右心室收缩功能，而采用传统超声心动图测量三尖瓣舒张早期（E）和晚期（A）舒张期血流速度及组织多普勒超声心动图测量三尖瓣侧壁环舒张早期（Ea）和晚期（Aa）舒张期速度来评估舒张功能。心肌做功指数作为整体功能的指标。在适当情况下使用配对t检验或Wilcoxon检验进行统计分析。
E显著降低（HD前为68±13cm/s，HD后为56±12cm/s；p<0.0001），但A未降低（p=0.797）。HD前TAPSE为1.84±0.34cm，HD后显著增加至2.03±0.20cm（p=0.006）。透析后右心室MPI、Sa和Aa无显著变化（分别为p=0.504；p=0.118和p=0.150），而Ea从11.3±3.4cm/s降至8.8±2.5cm/s（p<0.001）。HD后Ea/Aa比值也从0.84±0.44显著降至0.69±0.35（p=0.007）。
本研究结果表明，在接受定期血液透析的终末期肾衰竭患者中，右心室收缩功能参数如Sa和MPI与前负荷无关，而右心室舒张功能的传统及组织多普勒参数则依赖于前负荷。
