Bruch Christian, Rothenburger Markus, Gotzmann Michael, Wichter Thomas, Scheld Hans H, Breithardt Günter, Gradaus Rainer
Department of Cardiology and Angiology, Hospital of the University of Münster, Münster, Germany.
Int J Cardiol. 2007 Jun 12;118(3):375-80. doi: 10.1016/j.ijcard.2006.06.066. Epub 2006 Oct 16.
In patients with chronic heart failure (CHF), chronic kidney disease (CKD) is associated with increased morbidity and mortality, but contributing mechanisms are not well defined. This study tested the impact of CKD on intracardiac conduction, diastolic function and prognosis in patients with underlying CHF.
We prospectively enrolled 269 patients with stable CHF, of whom 135 had CKD (estimated glomerular filtration rate (eGFR)<60 ml/min/1.73 m(2)). Echo measurements comprised left ventricular dimensions/volumes, ejection fraction, mitral E/A-ratio, deceleration time and tissue Doppler mitral annular velocities (S', E', A'). PQ and QRS intervals were derived from the 12-lead ECG. A cardiac event (cardiac death or urgent cardiac transplantation) was defined as combined study end point.
Patients with CKD had longer PQ and QRS intervals, and were in a poorer NYHA functional class as compared to patients without CKD. In patients with CKD, the mitral annular E' velocity was lower, the mitral E/E'-ratio was higher and a restrictive mitral filling pattern was more frequent. By linear regression analysis, PQ and QRS intervals and the mitral E/E'-ratio were inversely related to the eGFR. During a follow-up of 507+/-375 days, 39 patients suffered a cardiac event. In CKD patients, outcome was markedly poorer as compared to those without CKD (event-free survival rate 51% vs. 87% in those without KD, p=0.001)
In patients with CHF, CKD is associated with impaired intracardiac conduction and progressive diastolic dysfunction. Both mechanisms may contribute to increased morbidity and mortality of such patients.
在慢性心力衰竭（CHF）患者中，慢性肾脏病（CKD）与发病率和死亡率增加相关，但具体机制尚不明确。本研究检测了CKD对合并CHF患者的心内传导、舒张功能及预后的影响。
我们前瞻性纳入了269例稳定型CHF患者，其中135例患有CKD（估计肾小球滤过率（eGFR）<60 ml/min/1.73 m²）。超声心动图测量包括左心室大小/容积、射血分数、二尖瓣E/A比值、减速时间以及组织多普勒二尖瓣环速度（S'、E'、A'）。PQ和QRS间期由12导联心电图得出。将心脏事件（心源性死亡或紧急心脏移植）定义为联合研究终点。
与无CKD的患者相比，CKD患者的PQ和QRS间期更长，纽约心脏协会（NYHA）心功能分级更差。在CKD患者中，二尖瓣环E'速度更低，二尖瓣E/E'比值更高，限制性二尖瓣充盈模式更常见。通过线性回归分析，PQ和QRS间期以及二尖瓣E/E'比值与eGFR呈负相关。在507±375天的随访期间，39例患者发生了心脏事件。与无CKD的患者相比，CKD患者的预后明显更差（无事件生存率分别为51%和87%，p = 0.001）。
在CHF患者中，CKD与心内传导受损和进行性舒张功能障碍相关。这两种机制可能都导致了此类患者发病率和死亡率的增加。
