中国体外循环杂志2025，Vol.23Issue(4)：324-331,8.DOI:10.13498/j.cnki.chin.j.ecc.2025.04.08
维持性血液透析患者右室功能障碍与死亡风险的关系
Correlation between right ventricular dysfunction and mortality risk in maintenance hemodialysis patients
摘要
Abstract
Objective To evaluate the association between right ventricular dysfunction(RVD)and with the risk of cardiovascular events and all-cause mortality in patients undergoing maintenance hemodialysis(MHD).Methods Between February 2019 and February 2023,137 patients with end-stage renal disease(ESRD)who had undergone MHD for more than one year were assessed for cardiac function and followed up.The study endpoints included cardiovascular events and all-cause mortality.RVD was defined by meeting at least two of the following criteria:(1)tricuspid annular systolic escursion(TAPSE)<17 mm;(2)tricuspid regurgitation velocity<10 cm/s;or(3)right ventricular area change fraction<35%.Spearman correlation analysis was performed to assess relationships between various cardiac parameters.The COX proportional hazards model and Kaplan-Meier survival analysis were used to evaluate the association between RVD and endpoint events.Results Of the 137 patients,56(40.88%)were classified into the RVD group.Compared with the non-RVD group,the RVD group exhibited significantly higher left ventricular end-diastolic diameter(LVEDD),left ventricular end-diastolic volume index(LVEDVI),left ventricular end-systolic volume index(LVESVI),right ventricular end diastolic volume index(RVEDVI),right ventricular end systolic volume index(RVESVI),and the ratio of mitral flow velocity to annular velocity(E/e')(P<0.05).Conversely,the left ventricular stroke volume index(LVSVI),right ventricular stroke volume index(RVSVI),left ventricular ejection fraction(LVEF),and RVEF were significantly lower in the RVD group(P<0.05).Spearman correlation analysis revealed that RVEDVI was significantly positively correlated with LVEDD(rs=0.516),LVESD(rs=0.341),RVEDD(rs=0.519),LVEDVI(rs=0.491),LVESVI(rs=0.273),LVSVI(rs=0.331),RVESVI(rs=0.345),RVSVI(rs=0.664)and E/e'(rs=0.411),while being significantly negatively correlated with LVEF(rs=-0.233)and RVEF(rs=-0.342),all P<0.05.RVEF showed a significant negative correlation with LVEDD(rs=-0.176),LVESD(rs=-0.436),RVEDD(rs=-0.294),LVEDVI(rs=-0.202),RVESVI(rs=-0.384)and E/e'(rs=-0.229),and a positive correlation with LVSVI(rs=0.336),LVEF(rs=0.507),and RVSVI(rs=0.379),all P<0.05.A weak negative correlation was found between LVEF and E/e'(rs=-0.184,P=0.038).During a median follow-up of 18 months(from 3-18 months),34 patients(24.82%)reached the study endpoint.The incidence of endpoint events was significantly higher in the RVD group compared to the non-RVD group(P<0.001),and the event-free survival time was significantly shorter in the RVD group(P<0.001).COX regression analysis identified RVD as an independent risk factor for the occurrence of endpoint events(P<0.05).Conclusion Accurate assessment of right ventricular function is critical for prognostication in MHD patients,as right ventricular parameters provide valuable prognostic information and may assist in risk stratification of this patient population.关键词
维持性血液透析/右心室功能障碍/全因死亡/不良心血管事件/终末期肾病Key words
Maintenance hemodialysis/Right ventricular dysfunction/All-cause mortality/Cardiovascular events/End-stage renal disease引用本文复制引用
许康世,贾婧,李雪莲,朱成振,徐源,金爱卿..维持性血液透析患者右室功能障碍与死亡风险的关系[J].中国体外循环杂志,2025,23(4):324-331,8.基金项目
江苏省高等学校基础科学(自然科学)研究面上项目(20KJB320013) （自然科学）
