Sambi Ravinder S, Gaur A K, Hotchandani R, Aggarwal K K, Kaur Sukhwinder, Gupta Manjari, Jain Sunita, Krishna C K, Chopra H K, Anand V, Srivastava Sameer, Gupta Rakesh, Parashar S K
Department of Medicine and Cardiology, Moolchand Medcity, Escorts Heart Institute, JROP Healthcare, Metro Heart, New Delhi, India.
Indian Heart J. 2011 May-Jun;63(3):259-68.
We evaluated the chronic kidney disease (CKD) patients having different degree of uremia for the prevalence of Left Ventricular Hypertrophy (LVH), different patterns of left Ventricular Hypertrophy by echocardiographic variables to define the most sensitive and powerful predictor of cardiovascular disease (CVD) and premature morbidity and mortality.
We used clinical and biochemical data from the prospective study done by us to evaluate "The Echocardiographic assessment of cardiac functions in patients with chronic kidney disease". The diagnosis of CKD was made on the basis of serum creatinine (sCr) concentration of more than 1.5 mg/dl, persistent and with no evidence of recovery over a period of 3 months. Glomerular filtration rate (GFR) was calculated by the Modification of Diet in Renal Disease (MDRD) equation and cut-off for CKD was taken to be < 60 ml/min/1.73 m2 as per existing guidelines. The study population consisted of a total of 75 subjects divided into three groups of 25 subjects each, all between the age of 20-65 yrs:
Healthy normal controls (sCr < 1.5 mg/dl);
Patients with mild to moderate CKD (sCr 1.5 - 6.0 mg/dl); GROUP C: Patients with severe CKD (sCr > 6.0 mg/dl).
A progressive rise in prevalence of LVH was observed with the severity of kidney disease from 64% (mild/ moderate CKD group) to 96% (severe CKD group) and higher prevalence of LVH in females than males in the severe CKD group. The mean LVMI in both the groups of CKD was significantly higher than the healthy controls (76.62 +/- 10.97). Also, mean LVMI in severe CKD (139.23 +/- 17.47) patients was significantly higher than in mild/moderate CKD (114.91 +/- 15.20) patients. The prevalence of concentric remodeling in both the CKD groups was alike (20%). While that of concentric hypertrophy in severe CKD patients (68%) was significantly higher than in mild/moderate CKD group (40%) (p < 0.05), but no significant difference was observed for eccentric pattern of hypertrophy between the two CKD groups. This suggests that concentric hypertrophy is more prevalent in CKD patients.
The mean left ventricular mass index (LVMI) showed a proportionate increase with the severity of renal failure and a progressive rise with increase in severity of disease. Patients of CKD groups revealed occurrence of concentric remodeling which is a predictor of high vulnerability for progressing into concentric and eccentric hypertrophy. Hence early medical intervention may reverse the concentric remodeling, thereby preventing the advancement to concentric or eccentric LVH.
我们评估了不同程度尿毒症的慢性肾脏病（CKD）患者左心室肥厚（LVH）的患病率，通过超声心动图变量评估左心室肥厚的不同模式，以确定心血管疾病（CVD）以及过早发病和死亡的最敏感且有力的预测指标。
我们使用了我们进行的前瞻性研究中的临床和生化数据来评估“慢性肾脏病患者心脏功能的超声心动图评估”。CKD的诊断基于血清肌酐（sCr）浓度超过1.5mg/dl，持续3个月且无恢复迹象。根据肾脏病饮食改良（MDRD）方程计算肾小球滤过率（GFR），按照现有指南，CKD的截断值为<60ml/min/1.73m²。研究人群共75名受试者，分为三组，每组25名，年龄均在20 - 65岁之间：
A组：健康正常对照（sCr < 1.5mg/dl）；
B组：轻度至中度CKD患者（sCr 1.5 - 6.0mg/dl）；C组：重度CKD患者（sCr > 6.0mg/dl）。
随着肾脏疾病严重程度的增加，LVH患病率逐渐上升，从64%（轻度/中度CKD组）升至96%（重度CKD组），且重度CKD组中女性LVH患病率高于男性。CKD两组的平均左心室质量指数（LVMI）均显著高于健康对照组（76.62 +/- 10.97）。此外，重度CKD患者（139.23 +/- 17.47）的平均LVMI显著高于轻度/中度CKD患者（114.91 +/- 15.20）。CKD两组的向心性重构患病率相似（20%）。重度CKD患者的向心性肥厚患病率（68%）显著高于轻度/中度CKD组（40%）（p < 0.05），但两组间离心性肥厚模式无显著差异。这表明向心性肥厚在CKD患者中更为普遍。
平均左心室质量指数（LVMI）随肾衰竭严重程度呈比例增加，且随疾病严重程度增加而逐渐上升。CKD组患者出现向心性重构，这是进展为向心性和离心性肥厚的高易感性预测指标。因此，早期医学干预可能逆转向心性重构，从而防止进展为向心性或离心性LVH。
