Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Dongtan, Korea.
Hallym University, Kidney Research Institute, Seoul, Korea.
PLoS One. 2021 May 5;16(5):e0250653. doi: 10.1371/journal.pone.0250653. eCollection 2021.
Cardiovascular (CV) disease is the major cause of death in patients with end-stage kidney disease (ESKD). Left ventricular (LV) diastolic dysfunction reflects LV pressure overload and is common in patients with ESKD. Recently, there have been studies on the usefulness of central blood pressure (BP); however, the relationship between central BP and LV diastolic dysfunction is not clear in dialysis patients with preserved systolic function. The purpose of this study was to investigate the clinical implication of central BP on LV diastolic dysfunction and CV mortality in the ESKD patients with preserved LV systolic function.
This prospective observational cohort study investigated the effect of LV diastolic dysfunction on CV mortality in the ESKD patients with preserved systolic function using echocardiography. Vascular calcification was evaluated using the abdominal aortic calcification score, and aortic stiffness was determined by measuring pulse wave velocity (PWV). The predictors of CV mortality were analyzed using Cox proportional hazard analysis.
The subjects were comprised of 61 patients, with an average age of 54 years, 20 males (32.8%), and 25 diabetics (41.0%). There were 39 patients on hemodialysis and 22 patients receiving peritoneal dialysis treatment. During the mean follow-up period of 79.3 months, 16 patients (26.2%) died, and 7 patients (11.4%) died of CV events. The central systolic BP and diabetes were independent risk factors for LV diastolic dysfunction. In addition, patients with LV diastolic dysfunction had an increased CV mortality. When left atrial volume index and PWV were adjusted, the E/E' ratio was found to be a predictor of CV mortality.
Central systolic BP and diabetes were found to be significant risk factors for LV diastolic dysfunction. LV diastolic dysfunction can independently predict CV mortality in dialysis patients with preserved LV systolic function.
心血管疾病是终末期肾病（ESKD）患者死亡的主要原因。左心室（LV）舒张功能障碍反映 LV 压力负荷过重，在 ESKD 患者中较为常见。最近，有研究探讨了中心血压（BP）的有用性；然而，在具有保留的收缩功能的透析患者中，中心 BP 与 LV 舒张功能障碍之间的关系尚不清楚。本研究旨在探讨 LV 舒张功能障碍和 CV 死亡率与 ESKD 患者保留的 LV 收缩功能之间的关系。
本前瞻性观察性队列研究使用超声心动图探讨了 LV 舒张功能障碍对保留收缩功能的 ESKD 患者 CV 死亡率的影响。使用腹主动脉钙化评分评估血管钙化，通过测量脉搏波速度（PWV）来确定主动脉僵硬程度。使用 Cox 比例风险分析来分析 CV 死亡率的预测因素。
受试者包括 61 例患者，平均年龄 54 岁，男性 20 例（32.8%），糖尿病患者 25 例（41.0%）。有 39 例患者接受血液透析治疗，22 例患者接受腹膜透析治疗。在平均 79.3 个月的随访期间，16 例患者（26.2%）死亡，7 例患者（11.4%）死于 CV 事件。中心收缩压和糖尿病是 LV 舒张功能障碍的独立危险因素。此外，LV 舒张功能障碍患者的 CV 死亡率增加。当调整左心房容积指数和 PWV 时，E/E' 比值是 CV 死亡率的预测因素。
中心收缩压和糖尿病是 LV 舒张功能障碍的重要危险因素。LV 舒张功能障碍可独立预测具有保留的 LV 收缩功能的透析患者的 CV 死亡率。
