Left ventricular geometry and cardiovascular mortality based on haemodialysis patient autopsy analyses
Left ventricular geometry and cardiovascular mortality based on haemodialysis patient autopsy analyses
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DOI：
10.1111/j.1440-1797.2010.01266.x
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发表时间：
2010-08-01
期刊：
影响因子：
2.5
通讯作者：
Sugimoto, Tokuichiro
中科院分区：
文献类型：
--
作者：
Mimura, Imari;Nishi, Hiroshi;Sugimoto, Tokuichiro
目的：在终末期肾病（ESRD）患者中，左心室肥厚（LVH）是常见的，是心血管事件的风险。几何学上将LVH分为两大类，同心性和偏心性，越来越多的证据表明偏心性LVH对ESRD结局的负面影响大于同心性LVH。然而，有很少的研究心脏的结果，从终末期肾病患者尸检LVH的几何形状和mortality之间的关系进行了analysed.Methods：一项观察性研究，在2001年和2006年之间的30例血液透析患者的尸检结果在东京三井纪念医院。在那些死于心血管原因和那些死于非心血管原因的人之间，我们比较了心脏/体重比、左心室扩张和左心室纤维化的程度。心脏/体重比显著高于心血管死亡组（n = 11，11.7 +/- 2.5 g/kg）与非心源性死亡组（n = 19，8.05 +/- 0.7 g/kg）相比（P < 0.0001）。心血管死亡组左心室扩张的发生率明显高于非心血管死亡组（P = 0.016）。此外，心血管组左心室横截面纤维化面积（1.63 ± 1.6%）大于非心血管组（0.83 ± 1.7%，P = 0.04.Conclusion：本尸检研究表明，血液透析患者偏心性LVH与心血管死亡率密切相关。LVH的几何形状以及LVH的严重程度值得考虑作为心血管死亡率的临床预测因子。
Aim: In end-stage renal disease (ESRD) patients, left ventricular hypertrophy (LVH) is common and a risk for cardiovascular events. LVH is geometrically classified into two major groups, concentric and eccentric, and accumulating evidence suggests eccentric LVH has a more negative effect than concentric LVH on ESRD outcome. However, there have been very few studies on the cardiac findings from ESRD patient autopsy in which the relationship between LVH geometry and mortality was analyzed.Methods: An observational study was performed with the autopsy findings in 30 haemodialysis patient cases between 2001 and 2006 at Mitsui Memorial Hospital, Tokyo. Between those who died of a cardiovascular cause and those who died of non-cardiovascular causes, we compared the heart/bodyweight ratio, left ventricular dilatation, and the extent of fibrosis of the left ventricle.Results: Heart/bodyweight ratio was significantly higher (P < 0.0001) in the cardiovascular mortality group (n = 11, 11.7 +/- 2.5 g/kg) compared to the non-cardiac cause of death group (n = 19, 8.05 +/- 0.7 g/kg). The dilatation of the left ventricle was significantly more frequent in the cardiovascular than the non-cardiac cause of death group (P = 0.016). Additionally, the fibrotic area of left ventricular cross-section was larger in the cardiovascular (1.63 +/- 1.6%) than the non-cardiac group (0.83 +/- 1.7%, P = 0.04).Conclusion: This autopsy study indicates that eccentric LVH in haemodialysis patients is closely associated with cardiovascular mortality. LVH geometry, as well as LVH severity, is worthy of consideration as a clinical predictor for cardiovascular mortality.