2024-투석전후 심부전 진단의 차이(원저)_신호식
2024-투석전후 심부전 진단의 차이_원저.pdf
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Abstract
Background Patients with end-stage renal disease (ESRD) who are on hemodialysis (HD) have reduced vascular compliance
and are likely to develop heart failure (HF). In this study, we estimated the prevalence of HF pre- and post-HD
in ESRD using the current guidelines.
Methods We prospectively investigated HF in ESRD patients on HD using echocardiography pre- and post-HD. We
used the structural and functional abnormality criteria of the 2021 European Society of Cardiology guidelines.
Results A total of 54 patients were enrolled. The mean age was 62.6 years, and 40.1% were male. Forty-five patients
(83.3%) had hypertension, 28 (51.9%) had diabetes, and 20 (37.0%) had ischemic heart disease. The mean N-terminalpro
brain natriuretic peptide BNP (NT-proBNP) level was 12,388.8 ± 2,592.2 pg/dL. The mean ideal body weight
was 59.3 kg, mean hemodialysis time was 237.4 min, and mean real filtration was 2.8 kg. The mean left ventricular
ejection fraction (LVEF) was 62.4%, and mean left ventricular end-diastolic diameter was 52.0 mm in pre-HD. Post-HD
echocardiography showed significantly lower left atrial volume index (33.3 ± 15.9 vs. 40.6 ± 17.1, p = 0.030), tricuspid
regurgitation jet V (2.5 ± 0.4 vs. 2.8 ± 0.4 m/s, p < 0.001), and right ventricular systolic pressure (32.1 ± 10.3 vs. 38.4 ± 11.6,
p = 0.005) compared with pre-HD. There were no differences in LVEF, E/E′ ratio, or left ventricular global longitudinal
strain. A total of 88.9% of pre-HD patients and 66.7% of post-HD patients had either structural or functional abnormalities
in echocardiographic parameters according to recent HF guidelines (p = 0.007).
Conclusions Our data showed that the majority of patients undergoing hemodialysis satisfy the diagnostic criteria
for HF according to current HF guidelines. Pre-HD patients had a 22.2% higher incidence in the prevalence of functional
or structural abnormalities as compared with post-HD patients.
Keywords End-stage renal disease, Hemodialysis, Heart failure, Diagnosis
