Universidade Federal do Maranhão, São Luís, MA, Brasil.
Arq Bras Cardiol. 2012 Aug;99(2):714-23. doi: 10.1590/s0066-782x2012005000065. Epub 2012 Jul 5.
Patients with chronic kidney disease (CKD) on hemodialysis have high rates of cardiovascular morbidity and mortality. Although structural and functional echocardiographic alterations in patients undergoing hemodialysis have been the subject of several survival analysis studies, the prognostic value of these alterations is not well established in literature.
To determine the prognostic value of echocardiographic parameters in patients with CKD on hemodialysis.
Sixty consecutive patients with CKD on hemodialysis were clinically evaluated and underwent Doppler echocardiography, being followed for 19 ± 6 months. The outcome measures were fatal and nonfatal cardiovascular events and overall mortality. The predictive value of echocardiographic variables was evaluated by Cox regression model and survival curves were constructed using the Kaplan-Meier method and log rank test to compare them.
Rates of survival free of cardiovascular events, of cardiovascular and overall mortality in two years were 79.4%, 88.5% and 83% respectively. Diabetes, previous diagnosis of cardiovascular disease (CVD), ejection fraction, fractional shortening, left ventricular systolic diameter and E/e' ratio were predictors of cardiovascular outcome at univariate analysis. In the multivariate analysis, previous history of CVD (HR = 6.17, 95%CI: 1.7 - 22.2, p = 0.005) and moderate to severe diastolic dysfunction (HR = 3.76, 95%CI: 1.05 - 13.4, p = 0.042) were independent risk factors for cardiovascular events.
Moderate to severe diastolic dysfunction is an independent predictor of cardiovascular events in hemodialysis patients.
接受血液透析的慢性肾脏病（CKD）患者心血管发病率和死亡率较高。尽管已经有多项生存分析研究探讨了血液透析患者的结构性和功能性超声心动图改变，但这些改变的预后价值在文献中尚未得到很好的确定。
确定超声心动图参数在血液透析的 CKD 患者中的预后价值。
连续评估 60 例接受血液透析的 CKD 患者，并进行多普勒超声心动图检查，随访 19±6 个月。主要终点为致命和非致命心血管事件以及总死亡率。采用 Cox 回归模型评估超声心动图变量的预测价值，并采用 Kaplan-Meier 方法和对数秩检验构建生存曲线进行比较。
两年内无心血管事件、心血管和总死亡率的生存率分别为 79.4%、88.5%和 83%。糖尿病、先前诊断的心血管疾病（CVD）、射血分数、缩短分数、左心室收缩直径和 E/e'比值在单因素分析中是心血管结局的预测因素。在多因素分析中，先前的 CVD 病史（HR=6.17，95%CI：1.7-22.2，p=0.005）和中重度舒张功能障碍（HR=3.76，95%CI：1.05-13.4，p=0.042）是心血管事件的独立危险因素。
中重度舒张功能障碍是血液透析患者心血管事件的独立预测因素。
