Myocardial contractility does not determine the haemodynamic response during dialysis
Myocardial contractility does not determine the haemodynamic response during dialysis
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DOI：
10.1093/ndt/gfi088
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发表时间：
2005-11-01
影响因子：
6.1
通讯作者：
Zietse, R
中科院分区：
文献类型：
--
作者：
Ie, EHY;Krams, R;Zietse, R
背景。透析患者的左心室收缩功能障碍与透析低血压的发生有关。收缩末弹性（Ees）是心肌收缩力的一个相对负荷无关的参数，通过测试低血压倾向（HP）和低血压抵抗（HR）患者对硝酸甘油（NTG）的急性左心室（LV）反应来评估。方法。对 15 名没有明显瓣膜疾病或冠心病症状的患者进行透析前常规测量射血分数 (EF)。通过 Finapres 测量连续动脉压，用收缩压 (SBP) 作为左心室收缩末压的替代值。同时，使用自动边界检测测量 LV 面积。静脉 NTG 推注后，SBP 和 LV 面积数据在线结合，实时创建压力面积环。 Ees 通过连续压力区域环路的逐次分析离线确定。结果。 SBP 基线为 168 mmHg (128-188 mmHg)，降至 127 mmHg (79-161 mmHg)。收缩末期左心室面积从基线 6 cm(2) (1-12 cm(2)) 降至 4 cm(2) (1-10 cm(2))。 HP组的Ees（11mmHg cm(-2)；7-22mmHg cm(-2)）与HR组的Ees（9mmHg cm(-2)；4-16mmHg cm(-2)）没有差异。 EF 为 61%（45-73%）。 Ees与EF之间不存在相关性。结论。在没有临床表现心脏病的透析患者群体中，HP 组和 HR 组具有相似的 Ees。因此，这两种类型的透析患者不能通过心肌收缩力的差异来区分。这项研究的结果反对心肌收缩力降低在透析中低血压的发生中的作用。
Background. LV systolic dysfunction in dialysis patients has been implicated in the genesis of dialysis hypotension. End-systolic elastance (Ees), a relatively load-independent parameter of myocardial contractility, was assessed by testing the acute left ventricular (LV) response to nitroglycerine (NTG) in hypotensionprone (HP) and hypotension-resistant (HR) patients.Methods. Routine measurement of ejection fraction (EF) was done before dialysis in 15 patients without significant valvular disease or symptoms of coronary heart disease. Continuous arterial pressure was measured by Finapres, with systolic blood pressure (SBP) as surrogate for LV end-systolic pressure. Simultaneously, LV area was measured using automated border detection. SBP and LV area data were combined online to create pressure-area loops in real time following intravenous NTG bolus. Ees was determined offline by beat-to-beat analysis of consecutive pressure-area loops.Results. SBP, at baseline 168 mmHg (128-188mmHg), decreased to 127mmHg (79-161 mmHg). End-systolic LV area, at baseline 6 cm(2) (1-12 cm(2)), decreased to 4 cm(2) (1-10 cm(2)). Ees in the HP group (11mmHg cm(-2); 7-22mmHg cm(-2)) was not different from Ees in the HR group (9mmHg cm(-2); 4-16mmHg cm(-2)). EF was 61% (45-73%). There was no correlation between Ees and EF.Conclusions. In this population of dialysis patients without clinically manifest heart disease, the HP and HR groups had a similar Ees. Therefore, these two types of dialysis patients were not distinguished by a difference in myocardial contractility. The results of this study argue against a role for reduced myocardial contractility in the genesis of intradialytic hypotension.