Ultrasonic Evaluation Of Right Ventricular Function And The Influencing Factors Of Pulmonary Hypertension In Patients With Maintenance Hemodialysis

Objective:To evaluate the effect of maintenance hemodialysis(MHD)on right heart function in patients with chronic renal failure(ESRD),and to explore the incidence of pulmonary artery hypertension(PAH)in MHD patients.Methods:Sixty four ESRD patients who underwent MHD treatment in the dialysis room of the First Affiliated Hospital of Yangtze University from September 2018 to November 2019 were selected.Pulmonary systolic blood pressure was measured one month after arteriovenous fistula anastomosis and one year after dialysis,and they were divided into two groups according to the level of SPAP measured by the ultrasonic diagnostic instrument.The group with SPAP≥40mmhg was set as PAH group and the group without PAH.The examinee took the supine position,and used the Philips elite ultrasonic diagnostic instrument frequency 10-12MHZ probe(L11-3)to record the time average peak velocity and radial artery diameter at 2cm of the radial artery near the fistula opening at the arteriovenous fistulas,and the arteriovenous fistulas flow(AVPB)=TAPV×π(D/2)2 ×60ml/min.The subjects were placed in the left decubitus position,connected to the ECG,and the images of four consecutive cardiac cycles were collected and stored under the long axis of the left ventricular apex,four Chambers and two Chambers respectively.Using the S5-1 probe,Measurement of tricuspid annulus systolic displacement(TAPSE),peak velocity of tricuspid regurgitation,inferior vena cava(IVC)diameter and deep inspiratory collapse index,end-diastolic right ventricular wall thickness,left ventricular ejection fraction(LVEF),end diastolic area(EDA),end systolic area(ESA),Tricuspid valve early diastolic peak(TV-E),and Tricuspid valve late diastolic peak(TV-A),tricuspid tissue doppler TV-e and tricuspid TV-a.Clinical indicators and echocardiographic parameters between the two groups were evaluated,and the correlation between right ventricular function parameters and other parameters in MHD patients was analyzed.Risk factors for pulmonary hypertension were analyzed by logistic regression.Results:I.One month after the operation of AVF,the clinical data and ultrasound results were not statistically significant.After 1 year of dialysis,the incidence of pulmonary hypertension in 64 MHD patients was 29.69%(19/64)and the incidence of right ventricular hypertrophy was 21.88%(14/64).II.Compared with the Non-PAH group,the PAH group had a decrease in TAPSE(P<0.001),RVFAC(P<0.001),SPAP(P<0.001),LVEF(P<0.001),right ventricular wall thickening(P<0.05),and no statistically significant difference in vascular access flow between the two groups in AVFB(P=0.06),TV-E/A(P=0.11),TV-e/a(P=0.41).Ⅲ.SPAP was positively correlated with right ventricular wall thickness(r=0.452,P<0.05),and negatively correlated with TAPSE,RVFAC,and LVEF(r=-0.724,-0.617,-0.699,P<0.05).LVEF was positively correlated with TAPSE and RVFAC(r=0.511,0.465,P<0.05),and negatively correlated with SPAP and right ventricular wall thickness(r=-0.699,-0.434,P<0.05).IV.Logistic regression analysis showed that the Logistic regression models of AVFB and PAH were(regression coefficient b=0.003,OR=1,P=0.03),TAPSE and PAH were(regression coefficient b=2.03,OR=0.13,P<0.001),LVEF and PAH were(regression coefficient b=0.68,OR=0.51,P<0.001),and RVFAC,SPAP,Thickness of right ventricular wall and PAH were not significant.V.Although TAPSE,LVEF and PAH all have good logistic regression relationship,but from the classification table given by SPSS,the logistic regression model of TAPSE and PAH has better prediction effect The accuracy of prediction of non PAH is 97.78%,the accuracy of prediction of PAH is 94.74%,and the total accuracy is 96.87%.Conclusion:I.It was found that the left ventricular systolic function and right ventricular systolic function were not the same after one year of maintenance hemodialysis with AVF In the same degree,the diastolic function was not damaged.Ⅱ.This study found that AVFB is the influencing factor of pulmonary hypertension.The larger AVFB is,the higher the probability of pulmonary hypertension is.Ⅲ.TAPSE and LVEF are the main risk factors of PAH in MHD patients,and the accuracy of TAPSE in predicting PAH is higher than LVEF.Ⅳ.The decrease of left ventricular systolic function and right ventricular systolic function may be involved in the occurrence of pulmonary hypertension and right ventricular hypertrophy in MHD patients.Therefore,controlling the volume load of MHD patients and improving the left ventricular systolic function may delay the progress of PAH.