Department of Nephrology, AIB University Hospital, 14280 Bolu, Turkey.
Kidney Blood Press Res. 2013;37(6):622-30. doi: 10.1159/000355742. Epub 2013 Dec 14.
BACKGROUND/AIMS: Abnormalities in atrial electromechanical delay (EMD) times and mechanical functions are considered as independent predictors of atrial fibrillation. However, to date, effects of a single hemodialysis (HD) session and acute volume-preload changes on atrial-EMD functions have not been investigated by Tissue Doppler Echocardiography (TDE). The aim of the present study was to evaluate atrial-EMD times and mechanical functions in HD patients.
Thirty-five non-diabetic, normotensive HD patients and 35 healthy control subjects were enrolled in the study. Standard and TDE performed before mid-week dialysis session for hemodialysis group and on admission for control group.
Interatrial and left-right intraatrial-EMD intervals and left atrial mechanical volumes were significantly longer in hemodialysis group compared to controls (all p<0.01) and were reduced after HD session. Furthermore, removed ultrafiltration volume was associated with reduction in atrial-EMD intervals and functional volumes. LA-passive emptying volume, ultrafiltration volume, LV-E/E' ratio, and Vp were independent predictors of interatrial-EMD.
The present study confirms negative effects in HD patients of structural remodeling and reveals negative effects of electrical remodeling. Prolonged inter and intraatrial-EMD intervals should be the underlying pathophysiological factors of increased rate of atrial fibrillation in the HD population.
背景/目的：心房机电延迟（EMD）时间和机械功能的异常被认为是心房颤动的独立预测因子。然而，迄今为止，单次血液透析（HD）治疗和急性容量预负荷变化对心房-EMD 功能的影响尚未通过组织多普勒超声心动图（TDE）进行研究。本研究旨在评估 HD 患者的心房-EMD 时间和机械功能。
本研究纳入了 35 名非糖尿病、血压正常的 HD 患者和 35 名健康对照者。HD 组在透析中期前进行标准和 TDE 检查，对照组在入院时进行检查。
与对照组相比，HD 组的房间隔和左右房间内 EMD 间隔以及左心房机械容积明显更长（均 p<0.01），并且在 HD 治疗后减少。此外，去除的超滤量与心房-EMD 间隔和功能容积的减少有关。LA 被动排空容积、超滤量、LV-E/E' 比值和 Vp 是房间隔 EMD 的独立预测因子。
本研究证实了结构重塑对 HD 患者的负面影响，并揭示了电重塑的负面影响。延长的房间隔和房间内 EMD 间隔可能是 HD 人群心房颤动发生率增加的潜在病理生理因素。
