Parameters Derived from Myocardial Tissue Doppler Imaging Associated with Major Events in Patients with Uremia

以組織都卜勒超音波參數來預測洗腎病人的癒後

蕭世宏(Shih-Hung Hsiao) ； 林士凱(Shih-Kai Lin) ； 黃偉春(Wei-Chen Huang) ； 李秋燕(Chiu-Yen Lee) ； 楊淑聲(Shu-Hsin Yang) ； 邱寬饒(Kuan-Ran Chiou) ； 劉俊鵬(Chun-Peng Liu)

《Acta Cardiologica Sinica》 23卷4期 (2007/12) Pp. 254-262

摘要

背景　心血管疾病造成的死亡仍是洗腎病人的大問題，本研究在於使用心臟超音波來預測洗腎病人的癒後。
方法　九十五位洗腎病人接受心臟超音波及心肌組織超音波，在洗腎前後，測量舒張早期二尖瓣血流速與舒張早期二尖瓣心肌組織移動速度比例(E/Em)，以此來推測洗腎病人四年內的出事率。
結果　四年內的共有十三人死亡，十一人發生非死中性之重大事件，研究發現洗腎病人的重大事件多與心血管疾病相關，將病人依出事與否分為兩組，可以發現出事組有較高比例的冠心症患者及心收縮功能不良，洗腎前及洗腎後的E/Em也比較高，使用Cox regression model，發現年紀、心收縮功能、LV mass index (hazard ratio [HR]=1.021, 95% confidence interval [CI] 1.001-1.039, p=0.021)、及洗腎後E/Em(HR=3.054, 95% CI 1.118-11.184, p=0.009)對於評估癒後有重大影響。
結論　洗後E/Em如同心收縮功能一樣，對於評估洗腎病人的癒後有重大影響。

關鍵字

洗腎病人 ； 心肌組織超音波 ； 心血管疾病 ； 癒後

並列摘要

Background: High cardiovascular mortality in uremic patients is still a problem. This study was designed to assess some echocardiographic parameters to predict prognosis.
Methods: We enrolled 95 patients (19 with corollary arterial disease). All underwent conventional echocardiography and tissue Doppler imaging within 30 minutes before and after hemodialysis (H/D). We measured the ratio of the early-diastolic velocity of mitral inflow (E) to the early-diastolic velocity of the mitral annulus (Em) Patients received 4-year follow-up for major events (any-cause mortality and nonfatal cardiovascular events requiring hospitalization).
Results: Thirteen deaths and 11 nonfatal major events occurred. The prevalence of underlying coronary arterial disease was higher in patients with major events than in others (33% vs. 7%), as was the degree of left ventricular (LV) systolic dysfunction (LV ejection fraction 46%±10 vs. 52%±8). Baseline E/Em, either pre-dialytic or post-dialytic, was significantly lower in event-free patients (pre-dialytic 9.9±3.0 vs. 12.2±4.0, p=0.01; post-dialytic 9.2±2.9 vs. 12.3±3.6, p=0.002). On Cox regression, factors significantly affecting outcomes were age, LV ejection fraction, LV mass index (hazard ratio [HR]=1.021, 95% confidence interval [CI]1.001-1.039, p=0.021), and post-dialytic E/Em≥12 (HR=3.054, 95% CI 1.118-11.184, p=0.009).
Conclusion: Like LV dysfunction and LV mass index, a high post-dialytic E/Em was prognostic of major events.

並列關鍵字

Echocardiography ； Tissue Doppler imaging ； Uremia ； Cardiovascular mortality