Schroeder A P, Kristensen B O, Nielsen C B, Pedersen E B
Department of Cardiology, Aarhus University Hospital, Skejby, Denmark.
Blood Press. 1997 Sep;6(5):286-93. doi: 10.3109/08037059709062084.
Left ventricular hypertrophy and diastolic heart dysfunction have been reported in essential hypertension and in patients with chronic renal failure, treated with haemodialysis, but a close association with blood pressure (BP) level has not been uniformly documented. Thus, other factors could be involved in the pathogenesis of cardiac dysfunction. The aims of the present echocardiographic study were to investigate cardiac morphology and function in patients with chronic glomerulonephritis with mildly to moderately impaired renal function, and to study the relation between echocardiographic findings and glomerular filtration rate (GFR), BP and age. Twenty patients with chronic glomerulonephritis and 14 healthy controls, of the same age- and sex-distribution, were examined by 2D-, M-mode and pulsed-wave Doppler echocardiography. In patients, GFR was determined as plasma clearance of Cr-EDTA. The patients had significantly thicker left ventricular (LV) posterior walls in end diastole (8.7 vs 8.1 mm, p < 0.05), and a higher LV mass index (106.5 vs 93.8 g/m2, p < 0.05). Systolic functional indices, i.e. LV fractional shortening and LV ejection fraction, were statistically significantly lower in patients than in controls (p < 0.05). LV diastolic function in patients was characterized by a statistically significantly lower early peak flow velocity (E-Vmax) (0.66 compared with 0.8 m/s) and early to late peak flow velocity ratio (E/A ratio) (1.07 vs 1.41), as well as E/A ratio of time velocity indices (VTI-E/A) (1.45 vs 1.99) (p < 0.05). The right ventricular filling indices showed a tendency towards a lower E-Vmax in patients (0.55 compared with 0.62 m/s, p = 0.1). In patients, statistically significant negative correlations were found between age and mitral E/A ratio (r = -0.76, p < 0.0001), as well as LV VTI-E/A(r = -0.81, p < 0.0001). The same trend was seen for the tricuspid E/A ratio. No statistically significant correlations were found in patients between mitral or tricuspid E/A ratio and GFR, BP, LV mass or heart rate.
in a group of patients with chronic glomerulonephritis and mildly to moderately impaired renal function, it was found by means of echocardiography that there was a higher LV mass index and decreased systolic function, when compared with healthy controls. In addition, the patients had diastolic dysfunction of primarily the left ventricle. The echocardiographic findings were not correlated to BP level or renal function. This suggests that factors other than GFR or BP per se might be involved in the pathogenesis of cardiac dysfunction, at an early stage.
已有报道称，原发性高血压患者以及接受血液透析治疗的慢性肾衰竭患者存在左心室肥厚和舒张性心脏功能障碍，但血压（BP）水平与之的密切关联尚未得到一致证实。因此，其他因素可能参与了心脏功能障碍的发病机制。本超声心动图研究的目的是调查肾功能轻度至中度受损的慢性肾小球肾炎患者的心脏形态和功能，并研究超声心动图检查结果与肾小球滤过率（GFR）、血压和年龄之间的关系。对20例慢性肾小球肾炎患者和14例年龄和性别分布相同的健康对照者进行了二维、M型和脉冲波多普勒超声心动图检查。在患者中，GFR通过Cr-EDTA的血浆清除率来测定。患者舒张末期左心室（LV）后壁明显增厚（8.7 vs 8.1 mm，p < 0.05），左心室质量指数更高（106.5 vs 93.8 g/m2，p < 0.05）。患者的收缩功能指标，即左心室缩短分数和左心室射血分数，在统计学上显著低于对照组（p < 0.05）。患者的左心室舒张功能表现为早期峰值流速（E-Vmax）在统计学上显著降低（0.66比0.8 m/s）、早期与晚期峰值流速比值（E/A比值）降低（1.07 vs 1.41）以及时间速度指数的E/A比值（VTI-E/A）降低（1.45 vs 1.99）（p < 0.05）。右心室充盈指标显示患者的E-Vmax有降低趋势（0.55比0.62 m/s，p = 0.1）。在患者中，年龄与二尖瓣E/A比值（r = -0.76，p < 0.0001）以及左心室VTI-E/A（r = -0.81，p < 0.0001）之间存在统计学上显著的负相关。三尖瓣E/A比值也呈现相同趋势。在患者中，二尖瓣或三尖瓣E/A比值与GFR、血压、左心室质量或心率之间未发现统计学上显著的相关性。
在一组肾功能轻度至中度受损的慢性肾小球肾炎患者中，通过超声心动图发现，与健康对照者相比，其左心室质量指数更高且收缩功能降低。此外，患者主要存在左心室舒张功能障碍。超声心动图检查结果与血压水平或肾功能无关。这表明在疾病早期，除GFR或血压本身外，其他因素可能参与了心脏功能障碍的发病机制。
