Department of Nephrology, Ankara University School of Medicine, Ankara, Turkey.
Department of Cardiology, Ankara University School of Medicine, Ankara, Turkey.
Artif Organs. 2020 Oct;44(10):1081-1089. doi: 10.1111/aor.13698. Epub 2020 May 5.
The effects of acute changes during hemodialysis (HD) on the myocardium are not yet known. The invention of three-dimensional speckle tracking echocardiography (3DSTE) has offered clinicians a new method to assess the movements of ventricular segments simultaneously in three spatial directions. The aim of this study was to evaluate the effect of first weekly standard HD process on the left ventricle (LV) and right ventricle (RV) global and regional myocardial function in patients with normal left ventricle ejection fraction using 3DSTE-derived indices. Patients (n=38) receiving maintenance HD in our clinic who have no known cardiovascular disease are examined just before and after a HD session using 3DSTE. Demographic and comorbidity data, renal replacement treatment characteristics, and laboratory test results are recorded. 3DSTE analysis is performed to calculate the LV global longitudinal, circumferential area and radial peak systolic strain, as well as RV septum and free-wall longitudinal strain and fractional area change. Patients are aged 52.8 ± 13.6 years and 52.6% of them are male. Mean dialysis duration is 56 months. The LV strain values of the patients changed markedly before and after HD (GLS: -14.2 ± 5.2, -11.1 ± 4.6 [P < .001], GCS: -14.8 ± 4.2, -12.4 ± 5.28 [P < .009]; GRS: 41.5 ± 16, 33.3 ± 16.5 [P = .003]; AREA -24.7 ± 7.2, -20.1 ± 7.6 [P = .001], respectively). We could not demonstrate any improvement in RV strain values before or after HD. LV strain values are positively correlated with blood pressure variability during the dialysis sessions. LV function is preserved better after HD in patients on beta or calcium channel blocker therapy compared to those who do not use these agents (P < .001, P < .01, respectively). HD treatment results in deterioration in all LV strain directions but not in RV. Strain assessment may improve vascular risk stratification of patients on chronic HD.
目前尚不清楚血液透析（HD）过程中急性变化对心肌的影响。三维斑点追踪超声心动图（3DSTE）的发明为临床医生提供了一种新的方法，可以同时在三个空间方向上评估心室节段的运动。本研究旨在使用 3DSTE 衍生指数评估每周首次标准 HD 过程对射血分数正常的患者左心室（LV）和右心室（RV）整体和局部心肌功能的影响。在我们诊所接受维持性 HD 治疗且无已知心血管疾病的患者，在 HD 治疗前后使用 3DSTE 进行检查。记录人口统计学和合并症数据、肾脏替代治疗特征和实验室检查结果。进行 3DSTE 分析以计算 LV 整体纵向、周向面积和径向收缩期峰值应变，以及 RV 间隔和游离壁纵向应变和节段面积变化。患者年龄为 52.8±13.6 岁，其中 52.6%为男性。平均透析时间为 56 个月。HD 前后患者的 LV 应变值明显变化（GLS：-14.2±5.2，-11.1±4.6[P<.001]；GCS：-14.8±4.2，-12.4±5.28[P<.009]；GRS：41.5±16，33.3±16.5[P=.003]；AREA：-24.7±7.2，-20.1±7.6[P=.001]）。我们未能证明 HD 前后 RV 应变值有任何改善。LV 应变值与透析期间血压变异性呈正相关。与未使用这些药物的患者相比，接受β受体阻滞剂或钙通道阻滞剂治疗的患者 HD 后 LV 功能保存更好（P<.001，P<.01）。HD 治疗导致所有 LV 应变方向恶化，但不影响 RV。应变评估可能会改善慢性 HD 患者的血管风险分层。
