Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Consiglio Nazionale delle Ricerche, Istituto di Biometeorologia, Reggio Calabria, Italy.
J Am Geriatr Soc. 2011 Sep;59(9):1636-41. doi: 10.1111/j.1532-5415.2011.03564.x. Epub 2011 Aug 30.
To identify the main age-related factors responsible for cardiomyopathy in people with end-stage renal disease (ESRD).
Cross-sectional.
Dialysis unit.
Two hundred fifty-four individuals undergoing chronic dialysis.
Left ventricular (LV) systolic function (assessed according to midwall fractional shortening (mwFS)) and LV mass index (LVMI).
At echocardiography, 196 (77%) participants displayed LV hypertrophy (LVH) and 123 (48%) had LV systolic dysfunction. On univariate analysis, age was related directly to LVMI (correlation coefficient (r)=0.33, P<.001) and inversely to mwFS (r=-0.23, P<.001) and a 10-year increase in age was associated with 4.2-g/m(2.7) greater LVMI and 0.5% lower mwFS. Albumin, pulse pressure, cardiovascular comorbidities, and C-reactive protein were age-related risk factors for LVMI and mwFS, whereas hemoglobin was an age-dependent risk factor only for LVMI and heart rate and diabetes mellitus only for mwFS. After adjusting for age-related risk factors, the predictive value of age for cardiomyopathy was substantially less (-67%) and the age-dependent variability in LVMI and mwFS was much attenuated (-61%), and neither was significant.
This study suggests that in people with ESRD, the relationship between age and cardiomyopathy is largely dependent on age-related risk factors and that interventions focused on modifiable risk factors linked to age (e.g., malnutrition and inflammation) could attenuate the detrimental effect of aging on cardiovascular risk in the dialysis population.
确定导致终末期肾病（ESRD）患者心肌病的主要与年龄相关的因素。
横断面研究。
透析单位。
254 名接受慢性透析的个体。
左心室（LV）收缩功能（根据中层缩短分数（mwFS）评估）和左心室质量指数（LVMI）。
在超声心动图检查中，196 名（77%）参与者显示 LV 肥厚（LVH），123 名（48%）有 LV 收缩功能障碍。单因素分析显示，年龄与 LVMI 直接相关（相关系数（r）=0.33，P<.001），与 mwFS 呈负相关（r=-0.23，P<.001），年龄增加 10 岁与 LVMI 增加 4.2-g/m2.7 和 mwFS 降低 0.5%相关。白蛋白、脉压、心血管合并症和 C 反应蛋白是 LVMI 和 mwFS 的年龄相关危险因素，而血红蛋白仅是 LVMI 的年龄依赖性危险因素，心率和糖尿病仅与 mwFS 相关。在调整与年龄相关的危险因素后，年龄对心肌病的预测价值大大降低（-67%），LVMI 和 mwFS 的年龄依赖性变异性也大大减弱（-61%），均无统计学意义。
本研究表明，在 ESRD 患者中，年龄与心肌病之间的关系在很大程度上取决于与年龄相关的危险因素，而针对与年龄相关的可改变危险因素（如营养不良和炎症）的干预措施可能会减轻衰老对透析人群心血管风险的不利影响。
