Kim Bong-Joon, Bae Su-Hyun, Kim Soo-Jin, Im Sung-Il, Kim Hyunsu, Heo Jung-Ho, Shin Ho Sik, Kim Ye Na, Jung Yeonsoon, Rim Hark
Division of Cardiology, Department of Internal Medicine, Kosin University College of Medicine, Gospel Hospital, Busan, Korea.
Division of Nephrology, Department of Internal Medicine, Kosin University College of Medicine, Gospel Hospital, 262 Gamcheon-Ro, Seo-Gu, Busan, 49267, Korea.
J Cardiovasc Imaging. 2024 Jun 12;32(1):6. doi: 10.1186/s44348-024-00003-8.
Patients with end-stage renal disease (ESRD) who are on hemodialysis (HD) have reduced vascular compliance and are likely to develop heart failure (HF). In this study, we estimated the prevalence of HF pre- and post-HD in ESRD using the current guidelines.
We prospectively investigated HF in ESRD patients on HD using echocardiography pre- and post-HD. We used the structural and functional abnormality criteria of the 2021 European Society of Cardiology guidelines.
A total of 54 patients were enrolled. The mean age was 62.6 years, and 40.1% were male. Forty-five patients (83.3%) had hypertension, 28 (51.9%) had diabetes, and 20 (37.0%) had ischemic heart disease. The mean N-terminal-pro brain natriuretic peptide BNP (NT-proBNP) level was 12,388.8 ± 2,592.2 pg/dL. The mean ideal body weight was 59.3 kg, mean hemodialysis time was 237.4 min, and mean real filtration was 2.8 kg. The mean left ventricular ejection fraction (LVEF) was 62.4%, and mean left ventricular end-diastolic diameter was 52.0 mm in pre-HD. Post-HD echocardiography showed significantly lower left atrial volume index (33.3 ± 15.9 vs. 40.6 ± 17.1, p = 0.030), tricuspid regurgitation jet V (2.5 ± 0.4 vs. 2.8 ± 0.4 m/s, p < 0.001), and right ventricular systolic pressure (32.1 ± 10.3 vs. 38.4 ± 11.6, p = 0.005) compared with pre-HD. There were no differences in LVEF, E/E' ratio, or left ventricular global longitudinal strain. A total of 88.9% of pre-HD patients and 66.7% of post-HD patients had either structural or functional abnormalities in echocardiographic parameters according to recent HF guidelines (p = 0.007).
Our data showed that the majority of patients undergoing hemodialysis satisfy the diagnostic criteria for HF according to current HF guidelines. Pre-HD patients had a 22.2% higher incidence in the prevalence of functional or structural abnormalities as compared with post-HD patients.
接受血液透析（HD）的终末期肾病（ESRD）患者血管顺应性降低，且很可能发生心力衰竭（HF）。在本研究中，我们根据现行指南评估了ESRD患者HD前后HF的患病率。
我们前瞻性地利用HD前后的超声心动图对接受HD的ESRD患者的HF情况进行了调查。我们采用了2021年欧洲心脏病学会指南中的结构和功能异常标准。
共纳入54例患者。平均年龄为62.6岁，男性占40.1%。45例患者（83.3%）患有高血压，28例（51.9%）患有糖尿病，20例（37.0%）患有缺血性心脏病。N末端脑钠肽前体（NT-proBNP）的平均水平为12388.8±2592.2 pg/dL。平均理想体重为59.3 kg，平均血液透析时间为237.4分钟，平均实际滤过量为2.8 kg。HD前左心室射血分数（LVEF）的平均值为62.4%，左心室舒张末期内径的平均值为52.0 mm。HD后超声心动图显示，与HD前相比，左心房容积指数显著降低（33.3±15.9对40.6±17.1，p = 0.030），三尖瓣反流峰值流速V（2.5±0.4对2.8±0.4 m/s，p < 0.001），以及右心室收缩压（32.1±10.3对38.4±11.6，p = 0.005）。LVEF、E/E'比值或左心室整体纵向应变无差异。根据最新的HF指南，HD前88.9%的患者和HD后66.7%的患者在超声心动图参数方面存在结构或功能异常（p = 0.007）。
我们的数据显示，根据现行HF指南，大多数接受血液透析的患者符合HF的诊断标准。HD前患者功能或结构异常的患病率比HD后患者高22.2%。
