Echocardiography overestimates left ventricular mass in hemodialysis patients relative to magnetic resonance imaging
Echocardiography overestimates left ventricular mass in hemodialysis patients relative to magnetic resonance imaging
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DOI：
10.1046/j.1523-1755.1999.00786.x
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发表时间：
1999-12-01
影响因子：
19.6
通讯作者：
Jardine, AG
中科院分区：
文献类型：
--
作者：
Stewart, GA;Foster, J;Jardine, AG
背景。左心室肥厚（LVH）是一种常见的发现，也是慢性肾功能衰竭患者的一个强烈的不良预后因素。因此，准确测量左心室质量（LV质量）的方法是治疗这些患者的先决条件。最近的证据表明超声心动图高估了原发性高血压患者的左室质量，并且这种误差随着左室质量的增加而增加。我们研究了35例在最后一次透析后24小时内进行维持性血液透析的患者。左室质量通过超声心动图和磁共振成像（MRI）测量，间隔不到3小时。在同一次就诊时进行临床和动态血压（ABPM）、静息超声心动图和采血。32例患者两种方法均有结果。临床血压、ABPM、QT离散度均与左室质量相关，且与MRI值相关性更强。超声心动图的观察者内部和观察者之间的可变性明显更大（尽管与其他已发表的数据相似）。比较两种方法，左室质量值（回声减去磁共振）的差异随着平均质量和腔室直径的增加呈线性增加。在LVH和扩张存在时，超声心动图明显高估了相对于MRI的左室质量。这种高估是在超声心动图m型图像计算质量时所做的假设的结果，当左室几何形状异常时，这些假设无效。因此，这种错误在透析患者中被放大，大多数患者有LVH，并且血管内容量不断变化。
Background. Left ventricular hypertrophy (LVH) is a common finding and a strong adverse prognostic factor in patients with chronic renal failure. An accurate method of measuring left ventricular mass (LV mass) is therefore a prerequisite in the management of these patients. Recent evidence has suggested that echocardiography overestimates LV mass in patients with essential hypertension, and this error increases with increasing LV mass.Methods. We studied 35 patients on maintenance hemodialysis within 24 hours of their last dialysis. LV mass was measured by both echocardiography and magnetic resonance imaging (MRI) performed less than three hours apart. Clinic and ambulatory blood pressure (ABPM), resting echocardiogram, and blood sampling were performed at the same visit.Results. Thirty-two patients had results from both methods. Clinic blood pressure, ABPM, and QT dispersion all correlated with LV mass, with a stronger correlation observed for MRI values. Intraobserver and interobserver variability were significantly greater for echocardiography (although similar to other published data). Comparing the two methods, the difference in LV mass values (echo minus magnetic resonance) increased in a linear fashion with an increasing mean mass and chamber diameter.Conclusions. Echocardiography significantly overestimates LV mass relative to MRI in the presence of LVH and dilation. This overestimation is the result of assumptions made in the calculation of mass from echocardiography M-mode images, which are invalid when LV geometry is abnormal. This error is therefore amplified in dialysis patients, the majority of whom have LVH and in whom intravascular volume is constantly changing.