Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego · 2012
[Dilatation of the left atrium as one of the indicators of worse prognosis in patients treated with intermittent hemodialysis].
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Ratajewska Aniela, Grzegorzewska Alicja E, Wiesiołowska Agnieszka
Аннотация
UNLABELLED: Cardiovascular diseases are the most frequent cause of death in patients undergoing treatment with hemodialysis (HD). Echocardiography is the established method in diagnosis and searching for HD patients with an increased risk of death from cardiovascular events. The aim of the study was to show parameters, obtained also in the echocardiographic examination, which are helpful to distinguish persons with the worse prognosis among the group of HD patients.
MATERIAL AND METHODS: Observation was done in 56 patients. Echocardiographic examination was performed at baseline before and after HD. The observation lasted 26.3 +/- 13.6 months. The analysis included the effect of the patient demographic characteristics, clinical and echocardiographic parameters: gender, age, duration of renal replacement therapy, body mass index, presence of ischemic heart disease, chronic heart failure, presence of valvular defects, hypertension, pharmacological therapy, systolic and diastolic left ventricular function, the size of the left and right atrium, atrial volume changes that occur due to decreased blood volume during HD treatment on the death risk.
RESULTS: In the group of 56 patients significantly worse survival was shown in persons with symptoms of cardiac failure. After 3 years of the observational study in the group without diagnosis of chronic cardiac failure 90.9% patients survived, whereas in the group with diagnosis of cardiac failure 51.0% (p = 0.020). In the group of patients with diagnosis of severe valvular disease 14.3% survived, whereas in the group without severe valvular disease 66.1% survived, (p = 0.009). Among patients without diagnosis of arterial hypertension 30.0% survived; in the group with diagnosis of arterial hypertension 65.9% (p = 0.016). In the group of patients with left atrial dimension > 50 mm all patients died, whereas in the group of patients with left atrial dimension < or = 50 mm 62.6% (p = 0.010) survived.
CONCLUSIONS: HD patients with worse survival prognosis can be identified by echocardiographic examination showing risk factors which were severe valvular disease and dilatation of the left atrium.
MATERIAL AND METHODS: Observation was done in 56 patients. Echocardiographic examination was performed at baseline before and after HD. The observation lasted 26.3 +/- 13.6 months. The analysis included the effect of the patient demographic characteristics, clinical and echocardiographic parameters: gender, age, duration of renal replacement therapy, body mass index, presence of ischemic heart disease, chronic heart failure, presence of valvular defects, hypertension, pharmacological therapy, systolic and diastolic left ventricular function, the size of the left and right atrium, atrial volume changes that occur due to decreased blood volume during HD treatment on the death risk.
RESULTS: In the group of 56 patients significantly worse survival was shown in persons with symptoms of cardiac failure. After 3 years of the observational study in the group without diagnosis of chronic cardiac failure 90.9% patients survived, whereas in the group with diagnosis of cardiac failure 51.0% (p = 0.020). In the group of patients with diagnosis of severe valvular disease 14.3% survived, whereas in the group without severe valvular disease 66.1% survived, (p = 0.009). Among patients without diagnosis of arterial hypertension 30.0% survived; in the group with diagnosis of arterial hypertension 65.9% (p = 0.016). In the group of patients with left atrial dimension > 50 mm all patients died, whereas in the group of patients with left atrial dimension < or = 50 mm 62.6% (p = 0.010) survived.
CONCLUSIONS: HD patients with worse survival prognosis can be identified by echocardiographic examination showing risk factors which were severe valvular disease and dilatation of the left atrium.