Tamulėnaitė Eglė, Žvirblytė Rūta, Ereminienė Rūta, Žiginskienė Edita, Ereminienė Eglė
Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania.
Department of Nephrology, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania.
Medicina (Kaunas). 2018 Nov 13;54(5):87. doi: 10.3390/medicina54050087.
: Chronic kidney disease (CKD) increases the risk of cardiovascular diseases even in its early stages and is associated with structural and functional cardiac abnormalities. The aim of this study was to use speckle-tracking echocardiography (STE) to evaluate left and right ventricle mechanics and function, markers of subclinical dysfunction in patients with end-stage renal disease (ESRD) undergoing haemodialysis. : Patients with ESRD undergoing regular haemodialysis and with preserved left ventricle (LV) ejection fraction (EF) ( = 38) were enrolled in this retrospective study. The control group consisted of 32 age-matched persons with normal kidney function (glomerular filtration rate (GFR) >90 mL/min/1.73 m² according to Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)). Conventional 2D echocardiography and STE were performed in all patients. : 70 individuals, 31 (44.29%) males and 39 (55.71%) females, were included in the study. There were no significant differences in age, sex and body surface area between the groups. LV end diastolic diameter did not differ between the groups, while LV myocardial mass index was higher in the group of patients on haemodialysis (111.64 ± 27.99 versus 84.21 ± 16.99, < 0.001) and LV diastolic dysfunction (LVDD) was found in 31 (81.6%) patients of this group. LV global longitudinal strain (GLS) (-22.43 ± 2.71 versus -24.73 ± 2.03, < 0.001) and LV global circumferential strain (GCS) at the mitral valve and papillary muscles levels (-18.73 ± 3.49 versus -21.67 ± 2.22, < 0.001; -18.64 ± 2.75 versus -20.42 ± 2.38, = 0.005, respectively) were significantly lower in haemodialysis group patients. The parameters of the right ventricle (RV) free wall longitudinal function including RV GLS (-22.63 ± 3.04 versus -25.45 ± 2.48, < 0.001), were reduced in haemodialysis patients compared with the controls. However, RV fractional area change (FAC) did not differ between the groups ( = 0.19). : Patients with ESRD and preserved LV ejection fraction undergoing haemodialysis had a higher prevalence of LVDD and impaired LV longitudinal and circumferential deformation indices, as well as reduced RV longitudinal function and deformation parameters compared with the age-matched healthy controls. STE helps to detect subclinical LV and RV dysfunction in chronic haemodialysis patients.
慢性肾脏病（CKD）即使在早期阶段也会增加心血管疾病的风险，并且与心脏结构和功能异常相关。本研究的目的是使用斑点追踪超声心动图（STE）来评估接受血液透析的终末期肾病（ESRD）患者的左、右心室力学和功能，以及亚临床功能障碍的标志物。：本回顾性研究纳入了接受定期血液透析且左心室（LV）射血分数（EF）保留（=38）的ESRD患者。对照组由32名年龄匹配、肾功能正常的人组成（根据慢性肾脏病流行病学协作组（CKD-EPI），肾小球滤过率（GFR）>90 mL/min/1.73 m²）。所有患者均进行了传统二维超声心动图和STE检查。：70名个体纳入研究，其中男性31名（44.29%），女性39名（55.71%）。两组在年龄、性别和体表面积方面无显著差异。两组间LV舒张末期直径无差异，而血液透析患者组的LV心肌质量指数较高（111.64±27.99对84.21±16.99，<0.001），且该组31名（81.6%）患者存在LV舒张功能障碍（LVDD）。血液透析组患者的LV整体纵向应变（GLS）（-22.43±2.71对-24.73±2.03，<0.001）以及二尖瓣和乳头肌水平的LV整体圆周应变（GCS）（-18.73±3.49对-21.67±2.22，<0.001；-18.64±2.75对-20.42±2.38，分别为=0.005）显著降低。与对照组相比，血液透析患者右心室（RV）游离壁纵向功能参数包括RV GLS（-22.63±3.04对-25.45±2.48，<0.001）降低。然而，两组间RV面积变化分数（FAC）无差异（=0.19）。：与年龄匹配的健康对照组相比，接受血液透析且LV射血分数保留的ESRD患者LVDD患病率更高，LV纵向和圆周变形指数受损，RV纵向功能和变形参数降低。STE有助于检测慢性血液透析患者的亚临床LV和RV功能障碍。
