Department of Biomedical Engineering, University of Alberta, Edmonton, AB, Canada.
Department of Medicine, University of Alberta, Edmonton, AB, Canada.
J Nephrol. 2019 Aug;32(4):615-626. doi: 10.1007/s40620-019-00593-3. Epub 2019 Feb 18.
The cardiovascular morphology and function in long-term survivors of hemodialysis are not well described.
Single-center cross-sectional study nested within a prospective cohort study of 15 long-term (> 7.5 years) and 15 matched incident (< 6 months) hemodialysis patients with 15 external matched controls. Evaluations included heart structure, function and fibrosis (myocardial longitudinal relaxation time, native T1), and aortic dimensions and elasticity, using cardiovascular magnetic resonance (CMR). Coronary artery calcification (CAC) scores were evaluated from computed tomography (CT).
Incident hemodialysis patients had significantly increased left ventricular mass, greater aortic dimensions and reduced aortic distensibility compared to long-term survivors, whereas the CAC score was significantly higher in long-term than incident patients, median (95% CI) 1127 (10-3861) vs 14 (0-268). Both incident and long-term hemodialysis groups had significantly higher native T1 values compared to controls, mean (95% CI) 1300 ms (1273-1326), 1274 ms (1243-1305) versus 1224 ms (1202-1246), respectively, suggesting interstitial fibrosis or edema. Compared to controls, both hemodialysis groups also had significantly lower left ventricular ejection fraction: 48.7% (43.6-53.9), 54.0% (48.3-59.7) versus 62.2% (58.0-66.4) and longitudinal strain: 14.0% (11.7-16.2), 15.2% (12.7-17.7) versus 19.6% (17.8-21.5).
Incident hemodialysis patients had larger left ventricular mass and unfavorable aortic structure and function compared to long-term survivors, despite a lower CAC burden. Long-term survivors, despite normal ventricular mass and volumes, had signs of fibrosis or edema, given their significantly increased native T1 values.
长期接受血液透析幸存者的心血管形态和功能尚未得到很好的描述。
本研究为单中心、前瞻性队列研究中的病例对照研究，纳入 15 例长期（>7.5 年）和 15 例匹配的新发病例（<6 个月）血液透析患者，同时纳入 15 名外部匹配的对照者。使用心血管磁共振（CMR）评估心脏结构、功能和纤维化（心肌纵向弛豫时间、心肌 native T1），以及主动脉的维度和弹性。通过计算机断层扫描（CT）评估冠状动脉钙化（CAC）评分。
与长期幸存者相比，新发病例血液透析患者的左心室质量显著增加，主动脉维度更大，主动脉顺应性降低，而长期幸存者的 CAC 评分显著高于新发病例，中位数（95%CI）分别为 1127（10-3861）与 14（0-268）。与对照组相比，新发病例和长期幸存者血液透析组的 native T1 值均显著升高，平均值（95%CI）分别为 1300ms（1273-1326）和 1274ms（1243-1305），与对照组 1224ms（1202-1246）相比，提示间质纤维化或水肿。与对照组相比，两组血液透析患者的左心室射血分数均显著降低：48.7%（43.6-53.9）和 54.0%（48.3-59.7），与对照组 62.2%（58.0-66.4）相比，以及纵向应变：14.0%（11.7-16.2）和 15.2%（12.7-17.7），与对照组 19.6%（17.8-21.5）相比。
与长期幸存者相比，新发病例血液透析患者的左心室质量更大，主动脉结构和功能更差，尽管 CAC 负担较低。长期幸存者尽管心室质量和容积正常，但 native T1 值显著升高，提示存在纤维化或水肿。
