Analysis of Difficulties in Diagnosis and Grading of Heart Failure in Maintenance Hemodialysis Patients
Objective To explore the causes and suggestions of difficulty in diagnosing and grading heart failure in maintenance hemodialysis patients.Methods A total of 129 patients underwent dialysis in the hemodialysis room,Dongguan Qingxi Hospital from January 2022 to June 2023 were selected.The Chinese Guidelines for the Management of Chronic Heart Failure in Dialysis Patients were used for heart failure diagnosis and cardiac function classification.Patients were divided into 4 groups based on left ventricular ejection fraction(LVEF)and normal/abnormal diastolic function detected by echocardiography,and the differences between the groups were compared.Results Among the 129 patients,41 patients(31.78％)were definitely diagnosed as heart failure,75 patients(58.14％)were definitely non-heart failure,13 patients(10.08％)were difficult to diagnose definitely.The affecting factors in diagnosing were the difficulties in movements caused by stroke,fracture and poor vision,fatigue after dialysis,asthma,and senile dementia.Among 41 patients with heart failure,8 patients(19.51％)were difficult to grade heart function.The affectting factors in classification include the difficulties in movements caused by stroke,fracture,poor vision and fatigue after dialysis.B-type natriuretic peptide(BNP),left atrium,left ventricular end-diastole and left ventricular end-systole were compared among the 4 groups,and the differences were statistically significant(P＜0.05).Cardiac function is graded 4 from good to differential,grade Ⅰ,LVEF was normal,diastolic function was normal;Grade Ⅱ,LVEF was normal and diastolic function was abnormal;Grade Ⅲ,LVEF was abnormal,diastolic function was normal;Grade Ⅳ,LVEFwas abnormal,diastolic function was abnormal.Conclusion Difficulty in movement and fatigue after dialysis are the main reasons for the difficulty in diagnosing and grading heart failure in hemodialysis patients.For patients with difficult heart failure diagnosis or cardiac function classification,preliminary cardiac function classification can be performed based on their cardiac LVEF and diastolic function.
hemodialysisheart failurediagnostic criteriacardiac function classificationejection fractiondiastolic function
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