1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Eur Rev Med Pharmacol Sci. 2018 Nov;22(22):7945-7951. doi: 10.26355/eurrev_201811_16422.
Adrenomedullin (ADM) and brain natriuretic peptide (BNP) are known to be associated with elevated left ventricular filling pressures. However, little is known about this association in hemodialysis (HD) patients with preserved left ventricular ejection fraction (LVEF). Our objective was to evaluate the potential association between E/e' ratio and plasma levels of BNP and ADM in end-stage renal disease (ESRD) patients with preserved LVEF undergoing chronic hemodialysis.
The study group enrolled 62 ESRD patients treated with hemodialysis three times weekly. BNP and ADM plasma concentration measurements and echocardiographic examination were performed 30 minutes after hemodialysis. E/e' ratio, evaluated by Tissue Doppler imaging and measured at the basal septum, was used as a surrogate marker for assessing left ventricular filling pressures.
The mean age of patients was 62 ± 25 years. The mean BNP and ADM values after hemodialysis were 0.40 ± 6.73 ng/ml and 0.06 ± 2.12 ng/ml, respectively. Elderly patients with hypertrophied left ventricles and larger left atria displayed higher E/e' values. BNP (r = 0.324. p = 0.018) and ADM (r = 0.319, p = 0.042) plasma levels were positively and significantly associated with E/e΄. Multivariate regression analysis including BNP, ADM, age, hemodialysis duration, left ventricular end-systolic volume index, LVEF, left ventricular mass index and left atrium volume index, revealed that ADM (p-value 0.025) but not BNP levels, were independently associated with the E/e' ratio.
ADM, but not BNP, was independently associated with septal E/e' in HD patients with preserved LVEF. ADM plasma levels can be used as a surrogate index to assess left ventricular filling pressures in HD patients.
已知肾上腺髓质素（ADM）和脑钠肽（BNP）与左心室充盈压升高有关。然而，在左心室射血分数（LVEF）保留的血液透析（HD）患者中，对这种相关性知之甚少。我们的目的是评估在接受慢性血液透析的左心室射血分数（LVEF）保留的终末期肾病（ESRD）患者中，E/e' 比值与 BNP 和 ADM 血浆水平之间的潜在相关性。
该研究纳入了 62 名接受每周三次血液透析治疗的 ESRD 患者。在血液透析后 30 分钟进行 BNP 和 ADM 血浆浓度测量和超声心动图检查。通过组织多普勒成像评估并在基底间隔测量的 E/e' 比值，作为评估左心室充盈压的替代标志物。
患者的平均年龄为 62±25 岁。血液透析后 BNP 和 ADM 的平均值分别为 0.40±6.73ng/ml 和 0.06±2.12ng/ml。左心室肥厚和左心房较大的老年患者 E/e' 值较高。BNP（r=0.324，p=0.018）和 ADM（r=0.319，p=0.042）的血浆水平与 E/e'呈正相关且有统计学意义。包括 BNP、ADM、年龄、血液透析持续时间、左心室收缩末期容积指数、LVEF、左心室质量指数和左心房容积指数在内的多元回归分析显示，ADM（p 值为 0.025）而不是 BNP 水平与 E/e'比值独立相关。
ADM 而不是 BNP 与 HD 患者 LVEF 保留时的室间隔 E/e'独立相关。ADM 血浆水平可作为评估 HD 患者左心室充盈压的替代指标。
