超声心动图评估左心室心肌应变,作为诊断终末期慢性肾病患者肺动脉高压的无创方法

M. Khubutiya, E. V. Shuvalova, L. T. Khamidova, A. A. Ivannikov, A. Balkarov, I. Dmitriev, K. Alidzhanova
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摘要

背景。肺动脉高压是慢性肾脏病的常见并发症,发病率高达 50%。目前,慢性肾脏病患者肺动脉高压的无创诊断方法对预后的意义仍很重要。确定经胸超声心动图在诊断终末期慢性肾脏病患者肺动脉高压中的意义。研究组由 53 名慢性肾脏病 5D 期患者组成,他们于 2022 年在 N.V. Sklifosovsky 急诊医学研究所接受肾移植评估。对照组由 24 名健康志愿者组成。所有患者均按照标准方案进行了经胸超声心动图检查,并测定了左心室心肌应变指数。左心室整体纵向应变与肺动脉收缩压之间的相关性r=0.488(p<0.001),左心室整体环向应变与肺动脉收缩压之间的相关性r=0.545(p<0.001),均有统计学意义。回归分析表明,肺动脉收缩压每增加 1 mmHg,致死几率增加 13%(Odds ratio:1.13;95% Confidence interval:[1.05;1.22],p=0.002)。血液透析患者的特点是发生毛细血管前肺动脉高压,这严重影响了他们的预后。根据超声心动图确定左心室心肌应变指数,可在不使用侵入性诊断方法的情况下提供有关肺循环血流动力学的额外信息。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Echocardiographic assessment of left ventricular myocardial strain, as a non-invasive method for diagnosing pulmonary hypertension in patients with end-stage chronic kidney disease
Background. Pulmonary hypertension is a common complication of chronic kidney disease, with incidence of up to 50%. Currently, the prognostic significance of non-invasive diagnostic methods for pulmonary hypertension in patients with chronic kidney disease remains relevant.Aim. To determine the significance of transthoracic echocardiography in diagnosing pulmonary hypertension in patients with end-stage chronic kidney disease.Material and methods. The study group consisted of 53 patients with chronic kidney disease stage 5D who were evaluated for kidney transplantation at the N.V. Sklifosovsky Research Institute for Emergency Medicine in 2022. A control group was represented by 24 healthy volunteers. Transthoracic echocardiography was performed on all patients according to a standard protocol, with determination of left ventricular myocardial strain indices.Results. A statistically significant correlation was found between the left ventricular global longitudinal strain and pulmonary artery systolic pressure r=0.488 (p<0.001), as well as between the left ventricular global circumferential strain and pulmonary artery systolic pressure (r=0.545, p<0.001). Regression analysis showed that an increase in pulmonary artery systolic pressure by 1 mmHg increased the odds of lethal outcome by 13% (Odds ratio: 1.13; 95% Confidence interval: [1.05;1.22], p=0.002).Conclusions. Hemodialysis patients are characterized by the development of pre-capillary pulmonary hypertension, which significantly affects their prognosis. Determination of left ventricular myocardial strain indices based on echocardiography provides additional information on the hemodynamics of the pulmonary circulation without using invasive diagnostic methods.
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