Ultrasonic Cardiogram Study On The Change Of Heart Structure And Heart Function In Uremic And Hemodialysis Patients

Objective:Cardiovascular system damage is one of common complications in end-stage of renal failure of uremic patients, which severely affects their life quality and survival rate, and it is also one of common death causes of them. The damages of cardiovascular system are mainly in the change of heart shape and the disorder of cardiac systole and diastolic function. So it would be of great importance to diagnose the heart change correctly and timely for further treatment and predict the prognosis in clinic for the uremia patients. The study utilized the common echocardiography and TEI technology in approaching the hear shape change and heart function disorder among uremic patients and healthy persons and also among the patients of before and after hematodialysis treatment, aimed to assess the value of the echocardiography in diagnosing the uremic cardiac damage and evaluating the clinical significance, and in order to provide a woundless, precise and early examining methods for clinic to help the clinicians to diagnose the heart damages incorporated with uremia correctly and timely and then to make further reasonable treatments to improve the life quality and survival rate of the uremic patients.Methods: In this study, 36 patients (aged 60.2 in average) with uremia, 30 healthy controls (aged 57.0 in average) and 28 uremic patient (aged 62.8 in average) who adopted hematodialysis over 3 months were performed the common echocardiography. The intracardiac diameter,cardiac systole and diastolic function were measured and the TEI index was calculated. The contrast study was held between the uremic patients and healthy control group and between the patients of before and after hematodialysis treatment.Results:1. In the aspect of heart structure, compared with the healthy cases, the uremic patients showed significant cavity diameters differences in left and right ventricle. Obvious enlargement appeared in the cardiac diameters especially in the left atrial (LA) and left ventricle (LV). The thickness of the interventricular septum and posterior wall of left ventricle (PWLV) increased notably in diastolic and systolic phase. Significant increased LV mass and LVMI compared with the control group indicated the myocardial hypertrophy in LV. The diameter dilation of the cardiac cavity and the myocardial hypertrophy were simultaneous, which different from the structure changes in the three primary myocardial disease. The existence of pericardial effusion was considered to be related to noninflammatory cardipericarditis induced by toxin, which different from other types of myocardiopathy.2. In the aspect of heart function, both the cardiac systolic and the diastolic function decreased, especially the diastolic function, which proved that disorder of diastolic function in LV might be an early index of myocardial damage in uremic patients. The study also met the problem of pseudo-normalization and we made further research on it.3. The index TEI was utilized and the results showed significant abnormity of diastolic function in uremic group. There were no significant difference in the value of E/A between the uremia group before and after hematodialysis, but the index TEI showed obvious difference. The pseudo-normalization might be avoided in routine ECG by using of index TEI, which estimated the diagnosing significance of the TEI index and technique in uremic cardiac damage.4. The study showed significant differences of ECG display in cardiac damage in uremia compared with the healthy controls, and the 2D and Doppler ECG were a kind of practical, sensitive, and woundless examination, which help to guide clinical diagnosis, therapy and predictthe prognosis. The application of index TEI could provide powerful evidence in analyzing the cardiac diastolic function correctly and timely, and ensure the early diagnosis and treatment. This technique was easy to perform, practical and could be generally utilized in clinic.Conclusions:1. The study indicated that the heart shape changed in different extent. Compared with the healthy cases, the uremic patients showed enlarged heart, especially the left atrial (LA) and left ventricle (LV). The interventricular septum and posterior wall of left ventricle (PWLV) appeared obvious hypertrophy. Meanwhile, the left ventricular diastolic function notablely decreased and the systolic function decreased in some extent.2. The index TEI were more sensitive than the traditional ratio of E/A, which comprehensively reflect the integer function of ventricular diastole and systole. The index TEI could provide the basis for correct diagnosis in early stage and were valuable in judging the heart damages in uremic patients. It also had the merit of measuring conveniently, little variance between the cases and was good for generally utilizing in clinic.3. The hematodialysis treatment could help to prevent the stepwise enlargement of the heart, partly reverse the pachynsis of the left ventricle, and recuperate the impaired cardiac diastolic and systolic function.