Said Karim, Hassan Mohamed, Baligh Essam, Zayed Bahaa, Sorour Khaled
Department of Cardiovascular, Faculty of Medicine, Cairo University, Cario, Egypt.
Echocardiography. 2012 Oct;29(9):1054-9. doi: 10.1111/j.1540-8175.2012.01749.x. Epub 2012 Jun 5.
Heart failure is prevalent in end-stage renal disease (ESRD) patients on long-term dialysis. Detection of right ventricular (RV) dysfunction before starting dialysis may help to identify patients at a higher risk of developing heart failure.
To assess RV function in predialysis patients using tissue Doppler imaging (TDI) derived myocardial performance index of RV (MPI-RV).
Echocardiography including pulsed TDI of lateral tricuspid annulus was performed in 41 patients with ESRD before starting dialysis therapy and 12 age and gender matched healthy controls. RV dysfunction was defined as MPI > 0.4; a value above the median MPI in controls.
Compared to controls, ESRD patients had significantly higher blood pressure and lower hemoglobin level. MPI-RV was significantly impaired in ESRD patients compared to control (0.6 vs. 0.4, P < 0.001). RV dysfunction was identified in 23 ESRD patients (56%). ESRD patients had significantly lower e' velocity and e'/a' ratio as compared with controls. Pulmonary hypertension was detected in 15 (36.5%) patients. Among ESRD patients, no correlation was detected between MPI-RV and calculated mean pulmonary artery pressure (r = -0.13, P = 0.47), pulmonary artery systolic pressure (r =-0.12, P = 0.6), left ventricular ejection fraction (r = 0.294, P = 0.06), or MPI of left ventricle (r = 0.3, P = 0.065). ESRD patients with and without pulmonary hypertension had similar MPI-RV (0.6 vs.0.62, P = 0.32).
Subclinical RV dysfunction-as estimated by TDI derived MPI-is highly prevalent among ESRD patients even before starting dialysis therapy. Pulmonary hypertension is not significantly associated with RV dysfunction in these patients.
心力衰竭在接受长期透析的终末期肾病（ESRD）患者中很常见。在开始透析前检测右心室（RV）功能障碍可能有助于识别发生心力衰竭风险较高的患者。
使用组织多普勒成像（TDI）得出的右心室心肌性能指数（MPI-RV）评估透析前患者的右心室功能。
对41例开始透析治疗前的ESRD患者以及12名年龄和性别匹配的健康对照者进行了超声心动图检查，包括三尖瓣环外侧的脉冲TDI。右心室功能障碍定义为MPI>0.4；该值高于对照组MPI的中位数。
与对照组相比，ESRD患者的血压显著更高，血红蛋白水平更低。与对照组相比，ESRD患者的MPI-RV明显受损（0.6对0.4，P<0.001）。23例ESRD患者（56%）被发现存在右心室功能障碍。与对照组相比，ESRD患者的e'速度和e'/a'比值显著更低。15例（36.5%）患者检测到肺动脉高压。在ESRD患者中，未检测到MPI-RV与计算得出的平均肺动脉压（r=-0.13，P=0.47）、肺动脉收缩压（r=-0.12，P=0.6）、左心室射血分数（r=0.294，P=0.06）或左心室MPI（r=0.3，P=0.065）之间存在相关性。有和没有肺动脉高压的ESRD患者的MPI-RV相似（0.6对0.62，P=
