Parul Institute of Medical Science and Research, Parul University, Vadodara, Gujarat.
J Assoc Physicians India. 2022 Apr;70(4):11-12.
Cardiovascular disease (CVD) is the supreme cause of morbidity and mortality amid patients with chronic kidney disease (CKD). In spite of alteration for known CAD risk factors, including hypertension & diabetes, mortality risk dynamically intensifying with worsening condition of CKD. CKD is non-communicable disease typically caused by diabetes and hypertension. The extremity of CKD can be proficient by a reasonable serum creatinine-based estimated eGFR, which also indicates excretory kidney function, and elevated urinary albumin measured by the urinary albumin-to-creatinine ratio (ACR), which is a best predictor of kidney damage.
To assess the systolic & diastolic dysfunction in patients with Chronic Kidney Disease (CKD). Fifty patients with CKD were subjected to two-dimensional and M mode echocardiography for determination of systolic and diastolic dysfunction. ECG were performed to detect MI, ischemia, LVH and other cardiovascular abnormality. All patients were evaluated clinically, biochemically and radio logically and were diagnosed as chronic kidney disease (CKD). The left ventricular ejection fraction (LVEF) and fractional shortening (FS) were taken as measures of left ventricular (LV) systolic function. Diastolic function was determined by measuring E/A ratio by spectral Doppler LV inflow velocity. Echocardiographic findings of hypertensive and normotensive patients were compared.
Out of 50 patients studied, there were 35 males (70%) and 15 females (30%). Hypertension (60%) was leading cause of CKD. Echocardiography showed that left ventricular hypertrophy (LVH) was present in 74%. Systolic dysfunction as measured by reduced fractional shortening (< 25%) and decreased LVEF (< 50%) was present in 8 % and 12 % respectively. Diastolic dysfunction as denoted by E/A ratio of less than 0.75 or more than 1.8 was present in 60 % of patients. Regional wall motion abnormality (RWMA) was present in 12 %. Pericardial effusion was noted in 14 % of patients. Valvular calcification was noted in 8 % of CKD patients. Mean left ventricular internal diameter in diastole was 41 ± 6 mm. Mean Interventricular septum diameters in systole was11.9 ± 1.21 mm. Mean left atrium diameter was 29 ± 4 mm. Normotensive group was compared to hypertensive group. Statistically significant difference was noted in LVH and E/A ratio in hypertensive group as compared to normotensive group.
We conclude that left ventricular diastolic dysfunction also occurs in patients who having early stage of CKD. But patients with hypertensive CKD had higher prevalence of diastolic and systolic dysfunction as compared to normotensive counterparts.
评估慢性肾脏病（CKD）患者的收缩和舒张功能障碍。
对 50 例 CKD 患者进行二维和 M 型超声心动图检查，以确定收缩和舒张功能障碍。进行心电图检查以检测心肌梗死、缺血、左心室肥厚和其他心血管异常。所有患者均进行临床、生化和放射学评估，并诊断为慢性肾脏病（CKD）。左心室射血分数（LVEF）和分数缩短（FS）被用作左心室（LV）收缩功能的指标。通过测量频谱多普勒 LV 流入速度的 E/A 比值来确定舒张功能。比较高血压和正常血压患者的超声心动图结果。
在研究的 50 例患者中，有 35 例男性（70%）和 15 例女性（30%）。高血压（60%）是 CKD 的主要原因。超声心动图显示，左心室肥厚（LVH）占 74%。收缩功能障碍表现为分数缩短减少（<25%）和 LVEF 降低（<50%），分别占 8%和 12%。舒张功能障碍表现为 E/A 比值小于 0.75 或大于 1.8，占 60%的患者。节段性壁运动异常（RWMA）占 12%。14%的患者有心包积液。8%的 CKD 患者有瓣膜钙化。舒张期左心室内径平均值为 41±6mm。收缩期室间隔直径平均值为 11.9±1.21mm。左心房直径平均值为 29±4mm。将正常血压组与高血压组进行比较。与正常血压组相比，高血压组的 LVH 和 E/A 比值有统计学显著差异。
我们的结论是，即使在患有早期 CKD 的患者中，也会发生左心室舒张功能障碍。但与正常血压组相比，高血压 CKD 患者的舒张和收缩功能障碍更为常见。
