Tripepi Giovanni, Benedetto Francesco Antonio, Mallamaci Francesca, Tripepi Rocco, Malatino Lorenzo, Zoccali Carmine
Consiglio Nazionale Ricerche--Istituto Biomedicina, Institute of Biomedicine, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension and Division of Nephrology, University of Catania, Catania, Italy.
J Am Soc Nephrol. 2007 Apr;18(4):1316-22. doi: 10.1681/ASN.2006080881. Epub 2007 Mar 14.
Left atrial volume (LAV), as indexed by height(2.7), has recently emerged as an useful echocardiographic measurement to refine the estimate of cardiovascular (CV) risk in ESRD. Whether progression or regression in LAV has prognostic value in patients with ESRD is still unknown. The prognostic value for CV events of changes in LAV was tested in a cohort of 191 dialysis patients. Echocardiography was performed twice, 17 +/- 2 mo apart. Changes in LAV that occurred between the second and the first echocardiographic studies were used to predict CV events during the ensuing 27 +/- 13 mo. During the follow-up, there was a significant increase in LAV (from 10.5 +/- 5.0 to 11.6 +/- 5.6 ml/m(2.7); P < 0.001). After the second echocardiographic study, 76 patients died (52 [68%] of CV causes) and 33 had nonfatal CV events. The independent association between changes in LAV and CV events was analyzed in a multiple Cox regression model taking into account a series of potential confounders, including baseline LAV and left ventricular mass and geometry. In these models, a 1-ml/m(2.7) per yr increase in LAV was associated with a 12% increase in the relative risk for fatal and nonfatal CV events (P < 0.001). Changes in LAV predict incident CV events in dialysis patients independent of the corresponding baseline measurement and of left ventricular mass. Monitoring LA size by echocardiography is useful for monitoring CV risk in patients with ESRD.
以身高指数化的左心房容积（LAV）最近已成为一种有用的超声心动图测量指标，可用于优化对终末期肾病（ESRD）患者心血管（CV）风险的评估。LAV的进展或逆转在ESRD患者中是否具有预后价值仍不清楚。在一组191例透析患者中测试了LAV变化对CV事件的预后价值。超声心动图检查进行了两次，间隔17±2个月。第二次与第一次超声心动图研究之间发生的LAV变化用于预测随后27±13个月内的CV事件。在随访期间，LAV显著增加（从10.5±5.0增加到11.6±5.6 ml/m(2.7)；P<0.001）。在第二次超声心动图研究后，76例患者死亡（52例[68%]死于CV原因），33例发生非致命性CV事件。在多因素Cox回归模型中分析了LAV变化与CV事件之间的独立关联，该模型考虑了一系列潜在混杂因素，包括基线LAV、左心室质量和几何形状。在这些模型中，LAV每年每增加1 ml/m(2.7)，致命和非致命CV事件的相对风险增加12%（P<0.001）。LAV变化可独立于相应的基线测量值和左心室质量预测透析患者发生的CV事件。通过超声心动图监测左心房大小有助于监测ESRD患者的CV风险。
