Clinical and pathologic characteristics of dilated cardiomyopathy in hemodialysis patients
Clinical and pathologic characteristics of dilated cardiomyopathy in hemodialysis patients
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DOI：
10.1111/j.1523-1755.2005.00086.x
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发表时间：
2005-01-01
影响因子：
19.6
通讯作者：
Hara, K
中科院分区：
文献类型：
--
作者：
Aoki, J;Ikari, Y;Hara, K
背景。一些透析患者左心室（LV）功能受损，但没有冠状动脉疾病。这些患者的病理变化和预后尚未得到很好的描述。方法。我们对 40 名患有扩张型心肌病（DCM；射血分数 90 mL/m(2)，无冠状动脉疾病）的血液透析患者和 50 名患有特发性 DCM 的非透析患者（作为对照组）进行了左心室心内膜心肌活检。左心室活检后，对患者进行了平均 3.1 +/- 2.3 年的随访。结果。透析组的病理特征为严重的肌细胞肥大（肌细胞跨核平均直径：37.6 +/- 10.5 mum vs. 25.6 +/- 7.7 mum，P = 0.001）、肌细胞紊乱（30%）和广泛纤维化（左心室纤维化面积平均百分比：22.3 +/- 18.4% vs. 21.3）。 +/- 14.6%，P = NS）。这些病理特征类似于肥厚型心肌病的扩张期。通过多变量分析，在透析组中，高百分比的左心室纤维化面积是心源性死亡的唯一显着预测因素（P = 0.02）。严重纤维化（≥30%）透析患者心源性死亡的3年累积无事件生存率为42%，而无严重纤维化患者为82%（P=0.03）。结论。 DCM 透析患者心脏的病理特征是间质纤维化和严重的心肌细胞肥大，偶尔出现紊乱。左心室纤维化的程度是心源性死亡的有力预测因子。对于左心室纤维化面积比例较高的透析患者，需要仔细随访和治疗。
Background. Some dialysis patients have impaired left ventricular (LV) function without coronary artery disease. The pathologic changes and prognoses of these patients have not been well described.Methods. We performed LV endomyocardial biopsies on 40 hemodialysis patients with dilated cardiomyopathy (DCM; an ejection fraction 90 mL/m(2) without coronary artery disease), and on 50 nondialysis patients with idiopathic DCM as the control group. Following LV biopsies, the patients were followed-up for a mean of 3.1 +/- 2.3 years.Results. The pathologic characteristics of the dialysis group were severe myocyte hypertrophy (the mean myocyte diameter across the nucleus: 37.6 +/- 10.5 mum vs. 25.6 +/- 7.7 mum, P = 0.001), myocyte disarray (30%), and extensive fibrosis (the mean percent area of left ventricular fibrosis: 22.3 +/- 18.4% vs. 21.3 +/- 14.6%, P = NS). These pathologic characteristics resembled the dilated phase of hypertrophic cardiomyopathy. In the dialysis group, a high percent area of LV fibrosis was the only significant predictor of cardiac death by multivariate analysis (P = 0.02). The 3-year cumulative event-free survival rate for cardiac death in dialysis patients with severe fibrosis (more than 30%) was 42%, while that for patients without severe fibrosis was 82% (P = 0.03).Conclusion. The pathologic characteristics of the heart in dialysis patients with DCM are interstitial fibrosis and severe myocyte hypertrophy with occasional disarray. The extent of LV fibrosis is a strong predictor of cardiac death. Careful follow-up and treatment are necessary for dialysis patients with a high percent area of LV fibrosis.