Arnol M, Knap B, Oblak M, Buturović-Ponikvar J, Bren A F, Kandus A
Department of Nephrology, University Medical Center Ljubljana, Ljubljana, Slovenia.
Transplant Proc. 2010 Dec;42(10):4064-8. doi: 10.1016/j.transproceed.2010.09.044.
Cardiovascular events (CVE) are the leading cause of mortality in kidney transplant recipients. Increased left ventricular mass (LVM) is a risk factor for CVE. This study investigated the associations of LVM with impaired kidney graft function expressed as lower glomerular filtration rate (GFR) at 1 year after transplantation and future CVE beyond 1 year. The prospective study cohort included 68 nondiabetic recipients of a kidney transplant between January 2004 and December 2005 who underwent a transthoracic echocardiographic investigation at 1 year after transplantation. LVM and left ventricular hypertrophy (LVH) were assessed using 2-dimensional M-mode echocardiography. GFR was estimated (eGFR) by the 4-variable Modification of Diet in Renal Disease formula. Cox proportional hazards analysis was used to estimate cardiac CVE (angina pectoris, acute myocardial infarct, coronary angioplasty or bypass surgery, or sudden cardiac death) hazard ratios (HRs) for patients with LVH versus control subjects with no LVH at 1 year after transplantation. All patients had normal systolic function (ejection fraction >50%) with no symptoms or signs of heart failure. LVH was present in 44 patients (65%). LVM and incidence of LVH were increased in 28 patients with eGFR <60 mL/min/1.73 m(2) compared with 40 patients with eGFR ≥60 mL/min/1.73 m(2) (248 ± 61 g and 86% vs 210 ± 46 g and 50%, respectively; P < .01). After a median follow-up of 4.5 years, there were 18 (26.5%) cardiac CVE. The incidence of CVE was higher in patients with LVH than in patients with no LVH at 1 year after transplantation (36.4% vs 8.3%; P = .020). In adjusted analyses, LVH was associated with an increased risk for future CVE (HR, 4.69; 95% confidence interval, 1.02-21.5; P = .037). In kidney transplant recipients, a lower eGFR at 1 year after transplantation was associated with greater LVM and higher incidence of LVH. Presence of LVH was associated with an increased risk for future CVE.
心血管事件（CVE）是肾移植受者死亡的主要原因。左心室质量（LVM）增加是CVE的一个危险因素。本研究调查了LVM与移植后1年时以较低肾小球滤过率（GFR）表示的移植肾功能受损以及1年后未来CVE之间的关联。前瞻性研究队列包括2004年1月至2005年12月期间接受肾移植的68例非糖尿病受者，他们在移植后1年接受了经胸超声心动图检查。使用二维M型超声心动图评估LVM和左心室肥厚（LVH）。通过4变量肾病饮食改良公式估算GFR（eGFR）。采用Cox比例风险分析来估计移植后1年时LVH患者与无LVH的对照受试者发生心脏CVE（心绞痛、急性心肌梗死、冠状动脉成形术或搭桥手术或心源性猝死）的风险比（HRs）。所有患者收缩功能正常（射血分数>50%），无心力衰竭症状或体征。44例患者（65%）存在LVH。与40例eGFR≥60 mL/min/1.73 m²的患者相比，28例eGFR<60 mL/min/1.73 m²的患者LVM和LVH发生率增加（分别为248±61 g和86% vs 210±46 g和50%；P<.01）。中位随访4.5年后，发生18例（26.5%）心脏CVE。移植后1年时，LVH患者的CVE发生率高于无LVH的患者（36.4% vs 8.3%；P=.020）。在多因素分析中，LVH与未来CVE风险增加相关（HR，4.69；95%置信区间，1.02 - 21.5；P=.037）。在肾移植受者中，移植后1年时较低的eGFR与更大的LVM和更高的LVH发生率相关。LVH的存在与未来CVE风险增加相关。
