Collegium Medicum, Jan Kochanowski University in Kielce, Al. IX Wieków Kielc 19A, 25-317, Kielce, Poland.
Department of Nephrology, Wojewódzki Szpital Zespolony in Kielce, Kielce, Poland.
Sci Rep. 2022 Jan 10;12(1):456. doi: 10.1038/s41598-021-04186-8.
Pulmonary hypertension (PHT) is associated with increased mortality in hemodialysis (HD) patients. The ventricular gradient optimized for right ventricular pressure overload (VG-RVPO) is sensitive to early changes in right ventricular overload. The study aimed to assess the ability of the VG-RVPO to detect PHT and predict all-cause and cardiac mortality in HD patients. 265 selected HD patients were enrolled. Clinical, biochemical, electrocardiographic, and echocardiographic parameters were evaluated. Patients were divided into normal and abnormal VG-RVPO groups, and were followed-up for 3 years. Abnormal VG-RVPO patients were more likely to be at high or intermediate risk for PHT, were older, had longer HD vintage, higher prevalence of myocardial infarction, higher parathormone levels, shorter pulmonary flow acceleration time, lower left ventricular ejection fraction, higher values of left atrial volume index, left ventricular mass index, and peak tricuspid regurgitant velocity. Both all-cause and CV mortality were higher in abnormal VG-RVPO group. In multivariate Cox analysis, VG-RVPO remained an independent and strong predictor of all-cause and CV mortality. In HD patients, abnormal VG-RVPO not only predicts PHT, but also all-cause and CV mortality.
肺动脉高压（PHT）与血液透析（HD）患者的死亡率增加有关。心室梯度优化右心室压力过载（VG-RVPO）对右心室过载的早期变化敏感。本研究旨在评估 VG-RVPO 检测 PHT 并预测 HD 患者全因和心脏死亡率的能力。 265 名选定的 HD 患者被纳入研究。评估了临床、生化、心电图和超声心动图参数。患者分为正常和异常 VG-RVPO 组，并随访 3 年。异常 VG-RVPO 患者更有可能处于 PHT 的高或中危状态，年龄更大，HD 治疗时间更长，心肌梗死发生率更高，甲状旁腺激素水平更高，肺血流加速时间更短，左心室射血分数更低，左心房容积指数、左心室质量指数和三尖瓣反流峰值速度更高。异常 VG-RVPO 组的全因和心血管死亡率均较高。多变量 Cox 分析显示，VG-RVPO 仍然是全因和心血管死亡率的独立且强有力的预测因素。在 HD 患者中，异常 VG-RVPO 不仅可以预测 PHT，还可以预测全因和心血管死亡率。
