Impact of diastolic dysfunction on physical function and body composition in maintenance hemodialysis patients

Maintenance Hemodialysis patients;diastolic dysfunction;physical function;body composition

Jeong, Jin Hee ; Wilund ; Kenneth R.

关键词: Maintenance Hemodialysis patients;    diastolic dysfunction;    physical function;    body composition;   

Others  :  https://www.ideals.illinois.edu/bitstream/handle/2142/49433/Jin%20Hee_Jeong.pdf?sequence=1&isAllowed=y

美国|英语

来源: The Illinois Digital Environment for Access to Learning and Scholarship

【 摘 要 】

ABSTRACTBackground: Cardiovascular (CV) complications are the main cause of death in maintenance hemodialysis (MHD) patients. Although metrics related to left ventricular systolic dysfunction (LVSD) such as ejection fraction (EF) are commonly used to predict adverse CV outcomes, LV diastolic dysfunction (LVDD) measures may provide better prognostic values in MHD patients because they are less sensitive to blood volume changes. Additionally, muscle wasting and declines in physical function are common in MHD patients. This can result from abnormalities in cardiac function, which can be further worsened by physical deconditioning. Little is known about the relationship between cardiac function and physical function in MHD patients. Aim: To evaluate the prevalence of LVDD and to assess its relationship to physical function and body composition in patients undergoing MHD.Methods: Walking performance, leg strength, and whole body lean mass (WBLM) by DXA were measured in 83 MHD patients (age=54.4± 12yr). Echocardiography was used to assess LVSD measured by EF and LVDD evaluated by mitral inflow velocity (E), peak late mitral inflow velocity(A), peak early diastolic mitral annular velocity(E’) and deceleration time of E (DT). We classified LVDD into: 1) mild DD (E/A< 0.8, E’ <8 (cm/s), E/E’<8, and DT <200ms) and 2) advanced DD (E/A>0.8, E’<8(cm/s), E/E’ >9, and DT <200ms).Results: The prevalence of LVDD was 48.2% (14.5% with mild DD and 33.7% with advanced DD) and the prevalence of LVSD (EF < 40%) was 14.5%. 50% of patients with LVSD also had LVDD. BMI was significantly higher in patients with LVDD (p=0.016). Gait speed, shuttle walk test, leg flexion and extension strength, and WBLM% were significantly higher in the group without LVDD than with LVDD (p=0.005, 0.007, 0.041, 0.031 and 0.002; respectively).However, there was no significant difference in any measure of physical function or body composition between patients with and without LVSD.Conclusion:This data indicates that LVDD is more closely related to physical function and body composition than LVSD in MHD patients, and suggests that LVDD may be an important therapeutic target.