Increased arterial stiffness adversely affects on the left ventricular diastolic function in hemodialysis patients

초록

Background and Objectives: Arterial stiffness is a major independent risk factor for cardiovascular morbidity and mortality in hemodialysis patients. It is hypothesized that arterial stiffness as a risk factor is attributable to the structural and functional changes of left ventricle(LV) caused by increased cardiac workload. So we investigated the relationship between brachial-ankle pulse wave velocity(baPWV) and diastolic dysfunction of left ventricle. Subjects and Methods: For 95 subjects(46 control patients, 49 hemodialysis patients), baPWV and echocardiographic indices for relaxation abnormality, i.e. transmitral E, A, E/A, DT, IVRT were measured just before hemodialysis session. Results: In a multiple linear regression analysis, E/A ratio was independently correlated with pulse rate(β= -0.322, p=0.001), right baPWV(β= -0.232, p=0.021) and age(β= -0.219, p=0.024). Among hemodialysis patients, pulse rate(β= -0.372, p=0.005) and prehemodialysis systolic BP(β= -0.336, p=0.012) were independent determinants of E/A ratio. Heart rate was significantly higher in women than in men(75.62 12.50 vs 68.70 10.65, p=0.049). In men, prehemodialysis systolic pressure was the only factors related to E/A. In women, rbaPWV was the sole factor related to the E/A ratio. Conclusion: Our results showed that increased baPWV adversely affects the LV compliance especially in female patients. It is suggested the role of arterial stiffness as a major cardiovascular risk can be in part related to LV diastolic dysfunction in hemodialysis patients.