Abstract: Objective  To analyze the clinical characteristics and changes of cardiac structure and function in maintenance hemodialysis (MHD) patients with different New York Heart Association cardiac function grade (NYHA grade).  Methods  A total of 148 MHD patients were divided into NYHA I group, NYHA II group, NYHA III group and NYHA IV group according to the NYHA classification of their heart function. Clinical data, laboratory indicators and Echocardiography results were collected. Changes of the above indicators were compared in the MHD patients with different NYHA grades.  Results   There were significant differences in weight gain in the hemodialysis period (t=2.057, P=0.049) and systolic blood pressure (t=2.415,       P=0.017) between NYHA III group and NYHA I group. With the increase of NYHA grade, the proportion of heart failure with preserve ejection fraction (HFpEF) patients reduced gradually, and the proportion of patients with heart failure and reduced ejection fraction (HFrEF) increased gradually (χ2=8.517, P=0.046); NT-proBNP and CRP increased gradually, and ALB and Hb decreased gradually, especially in NYHA IV group, with statistical significances among the four groups (χ2=9.465, P=0.009; F=6.745, P=0.048; F=6.235, P=0.037;             F=6.812, P=0.042); left atrial diameter (LA), left ventricular end-diastolic diameter (LVEDd) and the late diastolic peak flow velocity (VA) increased gradually, especially in NYHA IV group, and the differences were statistically significant among the groups (F=6.701, P=0.032; F=6.278, P=0.037; F=6.485, P=0.042); left ventricular ejection fraction (LVEF) decreased gradually, with significant differences among the groups (χ2=58.216, ＜0.000).  Conclusion  MHD patients with NYHA III or IV grade usually show more weight gain and poor blood pressure control during the dialysis period. With the increase of NYHA grade, microinflammatory state, malnutrition and anemia increased gradually, atrial and ventricular diameters increased mainly due to the decrease of diastolic function. Early identification of the decreased diastolic function should combine the values of early diastolic peak velocity (VE) and VA and their dynamic changes rather than limited to the E/A ratio.

Key words: NYHA grade, Maintenance hemodialysis, Cardiac structure