Dubin Ruth F, Beatty Alexis L, Teerlink John R, Schiller Nelson B, Alokozai Dean, Johansen Kirsten L
Echocardiography. 2014 Nov;31(10):1205-12. doi: 10.1111/echo.12552.
Diastolic dysfunction is common and associated with higher mortality in the end-stage renal disease (ESRD) population. E/E', a measure derived from tissue Doppler imaging (TDI), is a correlate of left ventricular (LV) filling pressures. E/E' may be viewed as a confirmatory marker of diastolic dysfunction, but it is not routinely used to quantify diastolic dysfunction. Whether E/E' is associated with N-terminal brain natriuretic peptide (NT-proBNP) or high sensitivity troponin T (hs-TnT) in this population is not known.
We performed echocardiograms and serology prior to the 2nd or 3rd dialysis session of the week on 35 chronic hemodialysis patients. We compared TDI parameters (E/E' and E' alone), traditional categories of diastolic function (normal, impaired, pseudonormal or restrictive), and ejection fraction (EF) as potential predictors of the outcomes NT-proBNP and hs-TnT.
Higher E/E' was associated with higher NT-proBNP (rho 0.48, P = 0.004) and hs-TnT (rho 0.37, P = 0.03). EF did not have statistically significant associations with NT-proBNP (rho -0.2, P = 0.4) or hs-TnT (rho -0.24, P = 0.16). As compared to patients with normal diastolic function, those with impaired or pseudonormal filling patterns did not have significantly different levels of NT-proBNP (P = 0.46); patients in traditional categories of worsened diastolic function actually had lower hs-TnT (P = 0.02). The associations of E/E' with higher NT-proBNP and hs-TnT persisted after multivariate adjustment for EF, LV mass, and volume status.
Tissue Doppler imaging may be more useful in evaluating cardiac function than traditional measures of diastolic dysfunction in the ESRD population.
舒张功能障碍在终末期肾病（ESRD）人群中很常见，且与较高的死亡率相关。E/E'是一种通过组织多普勒成像（TDI）得出的指标，与左心室（LV）充盈压相关。E/E'可被视为舒张功能障碍的确认标志物，但它并非常规用于量化舒张功能障碍。在该人群中，E/E'是否与N端脑钠肽（NT-proBNP）或高敏肌钙蛋白T（hs-TnT）相关尚不清楚。
我们在一周的第2次或第3次透析 session之前，对35例慢性血液透析患者进行了超声心动图检查和血清学检测。我们比较了TDI参数（单独的E/E'和E'）、舒张功能的传统分类（正常、受损、假性正常或限制性）以及射血分数（EF），将其作为NT-proBNP和hs-TnT结果的潜在预测指标。
较高的E/E'与较高的NT-proBNP（rho 0.48，P = 0.004）和hs-TnT（rho 0.37，P = 0.03）相关。EF与NT-proBNP（rho -0.2，P = 0.4）或hs-TnT（rho -0.24，P = 0.16）无统计学显著关联。与舒张功能正常的患者相比，充盈模式受损或假性正常的患者NT-proBNP水平无显著差异（P = 0.46）；舒张功能传统分类中病情加重的患者hs-TnT实际上更低（P = 0.02）。在对EF、左心室质量和容量状态进行多变量调整后，E/E'与较高的NT-proBNP和hs-TnT之间的关联仍然存在。
在ESRD人群中，组织多普勒成像在评估心脏功能方面可能比舒张功能障碍的传统测量方法更有用。
