Echokardiographie in der HD...1 Moller et al. Left atrial volume: a powerful predictor of survival...
Transcript of Echokardiographie in der HD...1 Moller et al. Left atrial volume: a powerful predictor of survival...
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Stephan HeylMedizinische Klinik III- Kardiologie
Universitätsklinikum Frankfurt
Echokardiographie in der HD
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Überblick
Das kardiorenale Syndrom
RCS- heart and kidney in patients in dialysis facilities
Echokardiographische Befunde und Parameter
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�Disorders of the heart and kidneys whereby acute or chronic dysfunction may induce acute or chronic dysfunction in the other�
C. Ronco, P. McCullough, S. D. Anker, et al., �Cardio-renal syndromes: an executive summary from the consensus conference of the Acute Dialysis Quality Initiative,� Contributions to Nephrology, vol. 165, pp. 54�67, 2010.
Das kardiorenale Syndrom
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CRS Typ I (akut)
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CRS Typ II (chronisch)
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Das kardiorenale Syndrom
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Goals Point prevalence of
CRS Describe
treatment patterns Evaluate physician
awareness
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Der Left Atrial Volume Index (LAVI)
Korrelation LA Volumen und Mortalität nach Myokardinfarkt , DCM und Patienten mit Peritonealdialyse
1 Moller et al. Left atrial volume: a powerful predictor of survival after acute myocardial infarction. Circulation 2003;107:2207-12.2 Modena et al Left atrial size is the major predictor of cardiac death and overall clinical outcome in patients with dilated cardiomyopathy: a long-term follow-up study. Clin Cardiol 1997;20:553-60.3 Kim et al. �Left Atrial Volume Is an Independent Predictor of Mortality in CAPD Patients�. Nephrology Dialysis Transplantation 26, Nr. 11 3732�3739.
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Bestimmung des LAVI Bestimmung erfolgt gemäß den
Richtlinien der ESC/ ASE Zwei Methoden
Errechnung nach der �area length� Methode
Biplan, modifiziert nach Simpson
Indizierung des Volumens auf die Körperoberfläche
Lang et al. �Recommendations for chamber quantification�. European journal of echocardiography: the journal of the Working Group on Echocardiography of the European Society of Cardiology 7, Nr. 2 (März 2006): 79�108.
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LV Masse
The RT3D data resulted in significantly larger LV long-axis dimensions and measurements of LV mass that correlated with CMR better (r0.90) than 2D (r0.79). The 2D technique underestimated LV mass (bias, 39%), whereas RT3D measurements showed only minimal bias (3%). The 95% limits of agreement were significantly wider for 2D (52%) than RT3D (28%). Additionally, the RT3D technique reduced the interobserver variability (37% to 7%) and intraobserver variability (19% to 8%).
Circ 2004;110;1814-18
VielversprechendeStudien
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Mitralringverkalkung3DE Empfohlen
10-50% der Patienten mit ESRD
Risikofaktoren Sekundärer Hyperpara Alter/ Dauer der HD
Raggi P, Bommer J, Chertow GM. Valvular calcification in hemodialysis patients randomized to calcium-based phosphorus binders or sevelamer. J Heart Valve Dis 2004; 13:134.
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Kalzifizierte Aortenklappenstenose3DE Empfohlen
15-20 % der Patiententen, bei 3-9% hochgradig
Schnelles Fortschreiten (0,23cm² versus 0,05- 0,1 cm²)
Baglin A. et al, Severe valcular heart disease in patientts on chronic dialysis, Ann Med Interne, 1997, 148:521
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Pulmonale Hypertonie3DE Empfohlen
Prävalenz 17-49% Geringer unter
Peritonealdialyse? Spezifische Therapie?
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Klappeninsuffizienzen und Hämodialyse3DE Empfohlen
Prävalenz von Klappeninsuffizienzen hoch
Vor Echo Gewichtsoptimierung sinnvoll
K/DOQI Workgroup. K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients. Am J Kidney Dis 2005; 45:S1.
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Vielen Dank für Ihre Aufmerksamkeit !
Echokardiographie -Labor:
PD Dr. Birgit AßmusAngie Schmitt & Christine Scheld
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Linkes Vorhofohr