Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China,
Cardiovascular Ultrasound and Non-Invasive Cardiology Department, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
Blood Purif. 2023;52(7-8):702-711. doi: 10.1159/000531188. Epub 2023 Aug 14.
As a key determinant of cardiovascular performance, vascular-arterial coupling (VAC) has been reported to be a predictor of clinical outcomes in various clinical scenarios. However, few studies have explored how acute fluid removal during hemodialysis (HD) impacts the interaction between cardiac function and the arterial system.
We recruited 317 HD patients from an established renal dialysis unit for this cross-sectional study and a total of 285 were included in the final analyses. We measured left ventricle end-systolic elastance (Ees), the effective arterial elastance (Ea), and VAC before and after HD using noninvasive echocardiographic measurements. We also compared echocardiographic and hemodynamic parameters in ventriculo-arterial coupling and ventriculo-arterial uncoupling patients.
HD significantly altered partial ventricular and vascular function parameters such as blood pressure, left ventricular end-diastolic volume, stroke volume, left ventricular ejection fraction, and systemic vascular resistance index. Ea increased following HD from 3.5 ± 1.4 to 4.2 ± 1.8 mm Hg/mL (p < 0.0001), Ees increased following HD from 7.9 ± 5.5 to 9.2 ± 6.9 mm Hg/mL (p = 0.04), whereas VAC did not markedly alter as a result of HD. Ventriculo-arterial uncoupling was found to be related to abnormal cardiac structure and worse systolic function.
VAC obtained from echocardiography is likely to be load-independent and useful as a reliable index for stratifying the risk of cardiovascular diseases in HD patients. Further investigations on larger patient cohorts are needed to further validate our findings.
血管-动脉耦合（VAC）作为心血管功能的关键决定因素，已被报道可预测各种临床情况下的临床结局。然而，很少有研究探讨血液透析（HD）过程中急性液体去除如何影响心脏功能和动脉系统之间的相互作用。
我们对一个已建立的肾脏透析中心进行了横断面研究，共招募了 317 名 HD 患者，其中 285 名患者最终纳入分析。我们使用非侵入性超声心动图测量了左心室收缩末期弹性（Ees）、有效动脉弹性（Ea）和 HD 前后的 VAC。我们还比较了心室-动脉耦联和心室-动脉解耦患者的超声心动图和血液动力学参数。
HD 显著改变了部分心室和血管功能参数，如血压、左心室舒张末期容积、每搏量、左心室射血分数和全身血管阻力指数。Ea 在 HD 后从 3.5±1.4 增加到 4.2±1.8mmHg/mL（p < 0.0001），Ees 在 HD 后从 7.9±5.5 增加到 9.2±6.9mmHg/mL（p=0.04），而 VAC 没有因 HD 而明显改变。发现心室-动脉解耦与异常的心脏结构和更差的收缩功能有关。
超声心动图获得的 VAC 可能是负荷独立的，并且作为 HD 患者心血管疾病风险分层的可靠指标是有用的。需要对更大的患者队列进行进一步研究，以进一步验证我们的发现。
