Determinants of hemodialysis-induced segmental wall motion abnormalities.
Determinants of hemodialysis-induced segmental wall motion abnormalities.
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DOI：
10.1111/hdi.12111
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发表时间：
2014-04
期刊：
影响因子：
--
通讯作者：
Johansen KL
中科院分区：
文献类型：
--
作者：
Dubin RF;Beatty AL;Teerlink JR;Schiller NB;Bolger AF;Alokozai D;Peralta CA;Johansen KL
在血液透析期间表现为心壁运动(WM)恶化的患者有较高的一年死亡率。我们试图确定透析引起的白质异常的危险因素。此外，我们还检查了血液透析对心功能其他参数的影响。40例患者在透析前直接进行超声心动图检查，并在透析的最后一小时(79次透析)进行超声心动图检查。年龄、心力衰竭(HF)或冠心病病史、血压或心率改变、高敏感性心肌肌钙蛋白T(hs-TNT)和N端脑利钠肽(NT-proBNP)是预测WM透析中恶化的候选因素。在40名患者中，8名患者(20%)出现节段性恶化，1名患者(3%)出现整体恶化，4名患者(10%)出现节段性改善。在透析期间，44%的患者的舒张期功能恶化，左心室射血分数基本不变。WM整体恶化的病例发生在一名无心力衰竭的患者的透析中高血压的环境中。令人惊讶的是，冠状动脉病史、血流动力学和血清学因素与透析期间节段性WM恶化无关。在调整了冠心病病史和其他心脏危险因素后，有心力衰竭病史的患者在透析期间发生节段性白质病变的风险增加了3倍(RR 3.1，95%CI[1.1，9]，p=0.04)。总而言之，有临床心衰病史的患者在透析中出现节段性WM恶化的风险更高。需要进一步的研究来确定这种联系的机制，以及心脏保护性药物是否可以改善血液透析的这种不良心脏影响。
Patients who demonstrate worsening of cardiac wall motion (WM) during hemodialysis have higher one-year mortality. We sought to identify risk factors for dialysis-induced WM abnormalities. Additionally, we examined the effects of hemodialysis on other parameters of cardiac function. Forty patients underwent echocardiography directly before dialysis and during the last hour of dialysis (79 dialysis sessions). Candidate predictors for intradialytic worsening of WM included age, a history of heart failure (HF) or coronary artery disease, changes in blood pressure or heart rate, high sensitivity cardiac troponin T (hs-TnT) and N-terminal brain natriuretic peptide (NT-proBNP). Among 40 patients, WM worsened segmentally in 8 patients (20%), worsened globally in 1(3%), and improved segmentally in 4(10%). Diastolic function worsened in 44% of patients, and left ventricular ejection fraction was largely unchanged during dialysis. The case of globally worsened WM occurred in the setting of intradialytic hypertension in a patient without heart failure. Surprisingly, history of coronary artery disease, hemodynamics, and serologic factors were not associated with worsened segmental WM during dialysis. After adjustment for history of coronary artery disease and other cardiac risk factors, patients with a history of HF had a 3-fold higher risk of worsening segmental WM during dialysis (RR 3.1, 95%CI [1.1, 9], p=0.04). In conclusion, patients with a history of clinical HF were at higher risk of intradialytic worsening of segmental WM. Further studies are needed to determine the mechanism of this association and whether cardioprotective medications could ameliorate this adverse cardiac effect of hemodialysis.
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DOI：
10.2215/cjn.05200610
发表时间：
2011-06-01
影响因子：
9.8
作者：
Jefferies, Helen J.;Virk, Bhupinder;McIntyre, Christopher W.
通讯作者：
McIntyre, Christopher W.
影响因子：
6.1
作者：
Dubin, Ruth F.;Teerlink, John R.;Johansen, Kirsten L.
通讯作者：
Johansen, Kirsten L.
影响因子：
--
作者：
Breidthardt, Tobias;Burton, James O.;McIntyre, Christopher W.
通讯作者：
McIntyre, Christopher W.
影响因子：
19.6
作者：
Aslam, S.;Santha, T.;Wilcox, C.
通讯作者：
Wilcox, C.
影响因子：
9.3
作者：
Giannitsis, Evangelos;Kurz, Kerstin;Katus, Hugo A.
通讯作者：
Katus, Hugo A.