腹膜透析患者心脏射血分数与心衰的关联
作者：Angela Yee-Moon Wang, Mei Wang, Christopher Wai-Kei Lam, Iris Hiu-Shuen Chan, et al. 来源：AJKD 日期：2013-03-12
导读
Heart Failure With Preserved or Reduced Ejection Fraction in Patients Treated With Peritoneal Dialysis
Background
Heart failure is one of the most frequent complications in dialysis patients. However, little is known of the significance of the entity “heart failure with preserved ejection fraction” (HFPEF) in this population. This study aimed to determine the prevalence, clinical profiles, and long-term outcomes of peritoneal dialysis patients with HFPEF.
Study Design
Prospective cohort study.
Setting & Participants
220 patients treated with peritoneal dialysis were recruited from a university teaching hospital in Hong Kong.
Predictor
Heart failure was defined clinically based on the presence of: (1) symptoms and signs, including dyspnea, increased jugular venous pressure, and basal crepitations; (2) radiographic evidence of pulmonary venous congestion or interstitial edema; and (3) resolution of symptoms, signs, and radiographic changes with hypertonic peritoneal dialysis exchanges. Based on a combination of clinical history of heart failure and echocardiography-derived ejection fraction, patients were classified as having no heart failure, HFPEF, and heart failure with reduced ejection fraction (HFREF).
Outcomes
All-cause mortality, cardiac death, heart failure, and fatal or nonfatal cardiovascular events.
Measurements
All patients underwent 2-dimensional echocardiography and tissue Doppler imaging at baseline and were followed up prospectively for clinical events for 4 years.
Results
86 (39%) patients had heart failure, of whom 54.7% had preserved ejection fraction ≥50% and 45.3% had reduced ejection fraction <50%. Patients with HFPEF were intermediate between those with no heart failure and those with HFREF in terms of blood pressure, prevalence of coronary artery disease, diabetes, cardiac biomarkers, left ventricular mass, volume, and ratio of early mitral inflow velocity to peak mitral annulus velocity. In the multivariable Cox regression analysis, patients with HFPEF showed an increased adjusted HR for cardiac death (2.57; 95% CI, 1.20-5.50), heart failure (HR, 2.25; 95% CI, 1.28-3.96), and fatal or nonfatal cardiovascular event (HR, 2.01; 95% CI, 1.26-3.21) compared with those with no heart failure, but the risk was lower compared with those with HFREF.
Limitations
The study included prevalent peritoneal dialysis patients and may introduce survival bias.
Conclusions
HFPEF is common in peritoneal dialysis patients (∼55% of all heart failure) and is associated with increased risk of mortality and adverse cardiovascular outcomes compared with those with no heart failure, although the risk was lower than in patients with HFREF. This entity needs to be more recognized in peritoneal dialysis patients.
http://www.ajkd.org/article/S0272-6386(13)00094-2/abstract
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