The Study On The Left Ventricular Function And Influential Factors In Hemodialysis Patients

Background:Cardiovascular disease is a major cause of death in chronic kidney disease patients,accounting for 40% death in hemodialysis patients.Echocardiogram is a simple,quick,radiation-free mothed to assesses cardiac function.Speckle tracking imaging(STI)is a novel technique that evaluates the regional cardiac function.Starting cardiovascular riskstratified management and identifying high risk patients is critical to improve the prognosis.Objectives:1.To summarize the influential factors of left ventricular function in hemodialysis patients and provide a basis for cardiovascular risk-stratified management in the future.2.To investigate the impact of percutaneous transluminal angioplasty in hemodialysis patients.Methods: Search the related thesis in the past 20 years,we got 58 theses in total.A total of 18 patients underwent ultrasound-guided percutaneous transluminal angioplasty were collected,the echocardiogram data were briefly analyzed.Results: 1.internal milieu disorder.Mineral and bone disorder plays a central role in impaired cardio function in CKD patients.Hyperphosphatemia leads to secondary hyperparathyroidism,PHT is associated with myocardial damage.Inflammatory and impaired endothelium are common in hemodialysis patients which contributed to cardiovascular disease.2.Hemodialysis-related myocardial demage.Hemodialysis-induced myocardial ischemia and stunning can cause irreversible myocardial damage.High-flux hemodialysis may benefits patients by cleaning circulating advanced glycosylated end products.Individualized dialysate temperature abrogates hemodialysis induced myocardial stunning.AVF has the best outcome in compare with CVC and peritoneal dialysis.Patients with elevated access flow/cardiac output ratios of more than 30% are at highest risk of developing high-output heart failure.4.Pulmonary hypertension is an independent predictor of cardiovascular events in hemodialysis patients.5.Total 18 patients underwent ultrasound-guided percutaneous transluminal angioplasty(PTA)were collected.There is no significant difference on systolic function after PTA.There is a significant increase in E/e' and LAVI(12.63±4.35 VS14.91±4.19;22.70±5.63 VS 25.21±6.62,P<0.05)which indicate impaired diastolic function.E/e' are strongly related to increased blood flow of brachial artery.Conclusion : The influential factors of left ventricular function inhemodialysis patients are: 1.internal milieu disorder;2.Hemodialysisinduced myocardial demage;3.Pulmonary hypertension.Impaired diastolic function appeared in patients who underwent ultrasound-guided percutaneous transluminal angioplasty.More research is required to see if systolic function is damaged.Assessing reginal cardio function provides a basis for cardiovascular risk-stratified management in the future.At the meantime,identifying high-risk patients is critical to improve the prognosis.