血液透析中的右心室-肺动脉耦合和肺动脉高压:对心脏结构变化和临床意义的见解。

IF 3 3区 医学 Q1 UROLOGY & NEPHROLOGY
Renal Failure Pub Date : 2025-12-01 Epub Date: 2025-02-23 DOI:10.1080/0886022X.2025.2466822
Kristina Buryskova Salajova, Jan Malik, Lucie Kaiserova, Zuzana Hladinova, Zdenka Hruskova, Simona Janakova, Vladimir Tesar, Satu Sinikka Pesickova, Kristyna Michalickova, Katarina Rocinova, Barbora Szonowska, Anna Valerianova
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引用次数: 0

摘要

目的:这项来自捷克晚期慢性肾病患者心力衰竭试验(ISRCTN18275480)的横断面分析检查了慢性血液透析患者的肺动脉高压和右心室-肺动脉耦合。本分析的目的是:1。分析肺动脉高压与右心室-肺动脉耦合与透析通路流量和电流水化的关系;2. 分析右心室-肺动脉分离引起的心脏结构性改变;3. 揭示捷克血液透析人群中肺动脉高压的患病率、病因和严重程度。方法:对336例血液透析患者进行超声心动图、血管通道流量测量、生物阻抗分析和实验室检测。结果:34%(114/336)的患者存在肺动脉高压,25%的患者存在右心室-肺动脉不耦合。透析动静脉通道的流量与估计的肺动脉收缩压和右心室-肺动脉耦合之间仅存在弱关联。通过估计中心静脉压和肺动脉收缩压来评估水合状态(Rho为0.6,p = 0.0001)和右心室-肺动脉耦合(Rho为-0.29,p = 0.002)之间有很强的相关性。右心室-肺动脉分离患者的心力衰竭患病率明显更高(88%比52%,p = 0.0003)。结论:血液透析患者应优先考虑优化容积状态和治疗心力衰竭,以防止肺动脉高压进展和右心室-肺动脉分离。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Right ventricular-pulmonary arterial coupling and pulmonary hypertension in hemodialysis: insights into structural cardiac changes and clinical implications.

Objectives: This cross-sectional analysis from the CZecking Heart Failure in patients with advanced Chronic Kidney Disease trial (ISRCTN18275480) examined pulmonary hypertension and right ventricular-pulmonary arterial coupling in patients on chronic hemodialysis. The aims of this analysis were: 1. To analyze relations between pulmonary hypertension and right ventricular-pulmonary arterial coupling with dialysis access flow and current hydration; 2. To analyze structural heart changes associated with right ventricular-pulmonary arterial uncoupling; 3. To reveal the prevalence, etiology and severity of pulmonary hypertension in the Czech hemodialysis population.

Methods: We performed expert echocardiography, vascular access flow measurements, bioimpedance analysis, and laboratory testing in 336 hemodialysis patients.

Results: Pulmonary hypertension was present in 34% (114/336) patients and right ventricular-pulmonary arterial uncoupling was present in 25% of patients with pulmonary hypertension. Only weak associations between the flow of the dialysis arteriovenous access and estimated pulmonary arterial systolic pressure and right ventricular-pulmonary arterial coupling was proved. There was a strong association between hydration status assessed by estimated central venous pressure with pulmonary arterial systolic pressure (Rho 0.6, p < 0.0001) and right ventricular-pulmonary arterial coupling (Rho -0.52, p < 0.0001) and association between overhydration to extracellular water ratio with pulmonary arterial systolic pressure (Rho 0.31, p = 0.0001) and right ventricular-pulmonary arterial coupling (Rho -0.29, p = 0.002). The prevalence of heart failure was significantly higher in patients with right ventricular-pulmonary arterial uncoupling (88% vs. 52%, p = 0.0003).

Conclusion: These findings suggest that optimizing volume status and treating heart failure should be prioritized in hemodialysis patients to prevent pulmonary hypertension progression and right ventricular-pulmonary arterial uncoupling.

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来源期刊
Renal Failure
Renal Failure 医学-泌尿学与肾脏学
CiteScore
3.90
自引率
13.30%
发文量
374
审稿时长
1 months
期刊介绍: Renal Failure primarily concentrates on acute renal injury and its consequence, but also addresses advances in the fields of chronic renal failure, hypertension, and renal transplantation. Bringing together both clinical and experimental aspects of renal failure, this publication presents timely, practical information on pathology and pathophysiology of acute renal failure; nephrotoxicity of drugs and other substances; prevention, treatment, and therapy of renal failure; renal failure in association with transplantation, hypertension, and diabetes mellitus.
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