Myocardial fibrosis and diastolic dysfunction in patients on chronic haemodialysis
Myocardial fibrosis and diastolic dysfunction in patients on chronic haemodialysis
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DOI：
10.1093/ndt/gfp747
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发表时间：
2010-06-01
影响因子：
6.1
通讯作者：
Chiariello, Massimo
中科院分区：
文献类型：
--
作者：
Losi, Maria Angela;Memoli, Bruno;Chiariello, Massimo
背景在许多心脏疾病中，左心室（LV）舒张功能障碍与心肌胶原含量有关。目前还没有关于终末期肾病（ESRD）患者接受血液透析的这种关系的数据。25例接受血液透析的终末期肾病患者进行了超声心动图研究。通过多普勒超声心动图，通过分析静息和负荷操作期间的LV充盈速度（代表LV充盈压的估计值），研究LV舒张功能。根据多普勒模式，判定给定患者的LV充盈压正常或轻度升高或中度或重度升高。心肌纤维化的存在是通过超声组织定征和背向散射积分来估计的，背向散射积分与心肌胶原含量相关。中度或严重升高的患者的背向散射积分高于LV充盈压正常或轻微升高的患者（背向散射积分：51.0 +/- 9.8 vs 41.6 +/- 5.6%; P = 0.008）。背向散射积分是舒张功能不全的一个强而独立的决定因素（比值比= 1.212; P = 0.040）。我们的数据支持这一假设，即在接受血液透析的ESRD患者中，心肌纤维化与左室舒张期心肌特性相关。
Background. Left ventricular (LV) diastolic dysfunction is linked to myocardial collagen content in many cardiac diseases. There are no data regarding such relationship in patients with end-stage renal disease (ESRD) undergoing haemodialysis.Methods. Twenty-five patients with ESRD undergoing haemodialysis were studied by echocardiography. LV diastolic function was investigated by Doppler echocardiography, by analysing LV filling velocities at rest and during loading manoeuvres, which represent an estimate of LV filling pressure. According to the Doppler pattern, LV filling pressure in a given patient was judged to be normal or slightly increased or to be moderately or severely increased. The presence of myocardial fibrosis was estimated by ultrasound tissue characterization with integrated backscatter, which in diastole correlates with the collagen content of the myocardium.Results. Integrated backscatter was higher in patients with moderate or severely increased than in patients with normal or slightly increased LV filling pressure (integrated backscatter: 51.0 +/- 9.8 vs 41.6 +/- 5.6%; P = 0.008). Integrated backscatter was a strong and independent determinant of diastolic dysfunction (odds ratio = 1.212; P = 0.040).Conclusion. Our data support the hypothesis that, in a selected population of patients with ESRD undergoing haemodialysis, myocardial fibrosis is associated with LV diastolic myocardial properties.