Lai Ashton C, Bienstock Solomon W, Sharma Raman, Skorecki Karl, Beerkens Frans, Samtani Rajeev, Coyle Andrew, Kim Tonia, Baber Usman, Camaj Anton, Power David, Fuster Valentin, Goldman Martin E
Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA.
Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
J Am Coll Cardiol. 2021 Mar 23;77(11):1470-1479. doi: 10.1016/j.jacc.2021.01.028.
Cardiovascular disease is the most common cause of death in patients with end-stage renal disease (ESRD). The initiation of dialysis for treatment of ESRD exacerbates chronic electrolyte and hemodynamic perturbations. Rapid large shifts in effective intravascular volume and electrolyte concentrations ultimately lead to subendocardial ischemia, increased left ventricular wall mass, and diastolic dysfunction, and can precipitate serious arrhythmias through a complex pathophysiological process. These factors, unique to advanced kidney disease and its treatment, increase the overall incidence of acute coronary syndrome and sudden cardiac death. To date, risk prediction models largely fail to incorporate the observed cardiovascular mortality in the CKD population; however, multimodality imaging may provide an additional prognostication and risk stratification. This comprehensive review discusses the cardiovascular risks associated with hemodialysis, and explores the pathophysiology and the novel utilization of multimodality imaging in CKD to promote a personalized approach for these patients with implications for future research.
心血管疾病是终末期肾病（ESRD）患者最常见的死亡原因。为治疗ESRD而开始透析会加剧慢性电解质和血流动力学紊乱。有效血管内容量和电解质浓度的快速大幅变化最终会导致心内膜下缺血、左心室壁质量增加和舒张功能障碍，并可通过复杂的病理生理过程引发严重心律失常。这些晚期肾病及其治疗所特有的因素增加了急性冠状动脉综合征和心源性猝死的总体发生率。迄今为止，风险预测模型在很大程度上未能纳入慢性肾脏病（CKD）人群中观察到的心血管死亡率；然而，多模态成像可能提供额外的预后评估和风险分层。这篇综述讨论了与血液透析相关的心血管风险，并探讨了CKD中多模态成像的病理生理学及新应用，以促进针对这些患者的个性化方法，对未来研究具有启示意义。
