RATIONALE & OBJECTIVE Left ventricular (LV) hypertrophy and dysfunction are associated with adverse outcomes in hemodialysis patients. Hypertension and hypervolemia play important roles in these cardiac abnormalities. We report on the prespecified secondary outcome, echocardiographic indexes of LV function, from a previously reported study of the effect of lung ultrasound (US)-guided dry weight reduction on systolic blood pressure. STUDY DESIGN Single-blind randomized trial. SETTINGS & PARTICIPANTS 71 clinically euvolemic hypertensive hemodialysis patients in Greece and Slovenia. INTERVENTION The active intervention group's (n=35) volume removal was guided by the total number of lung US B-lines observed every week before a midweek dialysis session. The usual-care group (n=36) was treated using standard-of-care processes that did not include acquisition of US data. OUTCOMES 2-dimensional and tissue Doppler echocardiographic indexes at baseline and study end (8 weeks) that evaluated left and right heart chamber sizes, as well as systolic and diastolic function. RESULTS Overall, 19 (54%) patients in the active intervention and 5 (14%) in the usual-care group had ultrafiltration intensification (P<0.001) during follow-up; changes in US B-lines (-5.3±12.5 vs+2.2±7.6; P<0.001) and dry weight (-0.71±1.39 vs+0.51±0.98kg; P<0.001) significantly differed between the active and usual-care groups. Inferior vena cava diameter decreased in the active compared with the usual-care group (-0.43±4.00 vs 0.71±4.82cm; P=0.03) at study end. Left (LA) and right (RA) atrial dimensions decreased more in the active group (LA surface, -1.09±4.61 vs 0.93±3.06cm2; P=0.03; RA surface -1.56±6.17 vs 0.47±2.31; P=0.02). LA volume index nominally decreased more in the active group (-2.43±13.14 vs 2.95±9.42mL/m2), though this was of borderline statistical significance (P=0.05). Reductions in LV end-diastolic diameter and volume were marginally greater in the active group. The change in LV filling pressures was significantly different in the active compared with the usual-care group (early transmitral diastolic velocities ratio [E/e'], -0.38±3.14 vs 1.36±3.54; P=0.03; E wave deceleration time, 35.43±85.25 vs-18.44±50.69; P=0.002]. Systolic function indexes were unchanged in both groups. In multivariable analysis, US B-line reduction was associated with a reduction in the E/e' LV ratio (OR, 4.542; 95% CI, 1.266-16.292; P=0.02). LIMITATIONS Exploratory study; small sample size. CONCLUSIONS A US-guided strategy for dry weight reduction is associated with decreased cardiac chamber dimensions and LV filling pressure, but no difference in systolic performance compared with usual care in hypertensive hemodialysis patients. FUNDING European Renal Association-European Dialysis and Transplant Association. TRIAL REGISTRATION Registered at ClinicalTrials.gov with study number NCT03058874.

中文翻译：

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高血压血液透析患者的肺超声干重评估和超声心动图测量：一项随机对照研究。

理由和目的血液透析患者的左心室肥大和功能障碍与不良预后相关。高血压和高血容量在这些心脏异常中起重要作用。我们从先前报道的对肺部超声（美国）指导的干体重减轻对收缩压的影响的研究中报告了预先确定的次要结局，即LV功能的超声心动图指标。研究设计单盲随机试验。场所和参与者希腊和斯洛文尼亚的71名临床上具有大血容量的高血压血液透析患者。干预主动干预组（n = 35）的体积清除受每周中半段透析前每周观察到的肺部US B线总数的指导。常规护理组（n = 36）使用的标准护理程序不包括获取美国数据的治疗。在基线和研究结束时（8周）评估二维和组织多普勒超声心动图指数，评估左心室和右心室的大小以及收缩和舒张功能。结果总体而言，积极干预中19例（54％）患者和常规护理组5例（14％）患者在随访期间出现了超滤强化（P <0.001）。活动组和常规护理组之间的美国B系（-5.3±12.5 vs + 2.2±7.6; P <0.001）和干重（-0.71±1.39 vs + 0.51±0.98kg; P <0.001）的变化显着不同。在研究结束时，与常规治疗组相比，主动下腔静脉直径减小（-0.43±4.00 vs 0.71±4.82cm； P = 0.03）。活跃组的左（LA）和右（RA）心房尺寸减少更多（LA表面，-1.09±4.61 vs 0.93±3.06cm2; P = 0.03; RA表面-1.56±6.17 vs 0.47±2.31; P = 0.02） 。活性组的LA体积指数名义上下降更多（-2.43±13.14 vs 2.95±9.42mL / m2），尽管这在统计学上具有临界意义（P = 0.05）。在活动组中，LV舒张末期直径和体积的减少幅度略大。与常规治疗组相比，主动治疗组左室充盈压的变化显着不同（舒张早期速度比[E / e']为-0.38±3.14 vs 1.36±3.54； P = 0.03； E波减速时间， 35.43±85.25 vs-18.44±50.69; P = 0.002]。两组的收缩功能指标均未改变。在多变量分析中，US B线降低与E / e'LV比降低有关（OR，4.542；95％CI，1.266-16.292；P ＝ 0.02）。局限性探索性研究；样本量小。结论：美国指导的干重减轻策略与降低心室尺寸和左室充盈压有关，但与高血压血液透析患者的常规治疗相比，其收缩功能无差异。资助欧洲肾脏协会-欧洲透析和移植协会。试验注册在ClinicalTrials.gov上注册，研究编号NCT03058874。资助欧洲肾脏协会-欧洲透析和移植协会。试验注册在ClinicalTrials.gov上注册，研究编号NCT03058874。资助欧洲肾脏协会-欧洲透析和移植协会。试验注册在ClinicalTrials.gov上注册，研究编号NCT03058874。