Echocardiography Criteria for Structural Heart Disease in Patients With End-Stage Renal Disease Initiating Hemodialysis

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• 作者：LaTonya J. Hickson ; MD^a ; ^b ; ^{hickson.latonya@mayo.edu" class="auth_mail" title="E-mail the corresponding author} ; Sara M. Negrotto ; MD^c ; Macaulay Onuigbo ; MD^a ; Christopher G. Scott ; MS^d ; Andrew D. Rule ; MD^a ; Suzanne M. Norby ; MD^a ; Robert C. Albright ; DO^a ; Edward T. Casey ; DO^a ; John J. Dillon ; MD^a ; Patricia A. Pellikka ; MD^e ; Sorin V. Pislaru ; MD ; PhD^e ; Patricia J.M. Best ; MD^e ; Hector R. Villarraga ; MD^e ; Grace Lin ; MD^e ; Amy W. Williams ; MD^a ; Vuyisile T. Nkomo ; MD ; MPH^e
• 关键词：chronic kidney disease ; heart failure ; hemodialysis ; left ventricle ; right ventricle ; structural heart disease
• 刊名：Journal of the American College of Cardiology
• 出版年：2016
• 出版时间：15 March 2016
• 年：2016
• 卷：67
• 期：10
• 页码：1173-1182
• 全文大小：658 K

文摘

Cardiovascular disease among hemodialysis (HD) patients is linked to poor outcomes. The Acute Dialysis Quality Initiative Workgroup proposed echocardiographic (ECHO) criteria for structural heart disease (SHD) in dialysis patients. The association of SHD with important patient outcomes is not well defined.

<h4 id="absSec_2">Objectivesh4>

This study sought to determine prevalence of ECHO-determined SHD and its association with survival among incident HD patients.

<h4 id="absSec_3">Methodsh4>

We analyzed patients who began chronic HD from 2001 to 2013 who underwent ECHO ≤1 month prior to or ≤3 months following initiation of HD (n = 654).

<h4 id="absSec_4">Resultsh4>

Mean patient age was 66 ± 16 years, and 60% of patients were male. ECHO findings that met 1 or more and ≥3 of the new criteria were discovered in 87% and 54% of patients, respectively. Over a median of 2.4 years, 415 patients died: 108 (26%) died within 6 months. Five-year mortality was 62%. Age- and sex-adjusted structural heart disease variables associated with death were left ventricular ejection fraction (LVEF) ≤45% (hazard ratio [HR]: 1.48; confidence interval [CI]: 1.20 to 1.83) and right ventricular (RV) systolic dysfunction (HR: 1.68; CI: 1.35 to 2.07). An additive of higher death risk included LVEF ≤45% and RV systolic dysfunction rather than neither (HR: 2.04; CI: 1.57 to 2.67; p = 0.53 for test for interaction). Following adjustment for age, sex, race, diabetic kidney disease, and dialysis access, RV dysfunction was independently associated with death (HR: 1.66; CI 1.34 to 2.06; p < 0.001).

<h4 id="absSec_5">Conclusionsh4>

SHD was common in our HD study population, and RV systolic dysfunction independently predicted mortality.