Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Am J Cardiol. 2013 Mar 1;111(5):712-6. doi: 10.1016/j.amjcard.2012.11.025. Epub 2012 Dec 8.
The prognosis of patients with diastolic heart failure (HF) is as poor as that of patients with systolic HF. Greater chronic kidney disease-associated mortality occurs in patients with left ventricular (LV) diastolic HF than in those with systolic HF. Indoxyl sulfate (IS), a uremic toxin, directly affects cardiac cells adversely in in vitro experiments. We investigated the association of IS, a uremic toxin, and chronic kidney disease with LV diastolic dysfunction in the clinical setting. The present study included 204 consecutive patients with preserved LV systolic function. To evaluate LV function, all patients underwent echocardiography. To measure the plasma IS levels and estimated glomerular filtration rate (eGFR), blood samples were obtained. Of the 204 patients, 75 (37%) had LV diastolic dysfunction. A significantly lower prevalence of LV diastolic dysfunction was present in patients with lower plasma IS levels (≤1.0 μg/ml) than those with greater plasma IS levels (38 [29%] vs 37 [51%], p <0.001). Furthermore, a significantly lower prevalence of LV diastolic dysfunction was present in patients with lower plasma IS levels and preserved eGFR than those with greater plasma IS levels and preserved eGFR, those with lower plasma IS levels and a reduced eGFR, or those with greater plasma IS levels and reduced eGFR (20 [21%] vs 18 [53%], p = 0.001; 20 [21%] vs 18 [46%], p = 0.004; and 20 [21%] vs 19 [56%], p <0.001, respectively). In conclusion, greater plasma IS levels or a reduced eGFR, or both, represent an increased risk of LV diastolic dysfunction.
在舒张性心力衰竭（HF）患者中的预后与收缩性 HF 患者一样差。与收缩性 HF 患者相比，左心室（LV）舒张性 HF 患者的慢性肾脏病相关死亡率更高。在体外实验中，尿毒症毒素吲哚硫酸酯（IS）直接对心脏细胞产生不利影响。我们在临床环境中研究了 IS，一种尿毒症毒素，与慢性肾脏病和 LV 舒张功能障碍的关系。本研究纳入了 204 例连续的左心室收缩功能正常的患者。为了评估 LV 功能，所有患者均接受了超声心动图检查。为了测量血浆 IS 水平和估算肾小球滤过率（eGFR），采集了血样。在 204 例患者中，有 75 例（37%）存在 LV 舒张功能障碍。与血浆 IS 水平较高的患者（38 [29%]比 37 [51%]，p<0.001）相比，血浆 IS 水平较低（≤1.0μg/ml）的患者 LV 舒张功能障碍的发生率明显更低。此外，与血浆 IS 水平较高且 eGFR 正常、血浆 IS 水平较高且 eGFR 降低、或血浆 IS 水平较低且 eGFR 降低的患者相比，血浆 IS 水平较低且 eGFR 正常的患者 LV 舒张功能障碍的发生率明显更低（20 [21%]比 18 [53%]，p=0.001；20 [21%]比 18 [46%]，p=0.004；和 20 [21%]比 19 [56%]，p<0.001）。总之，较高的血浆 IS 水平或降低的 eGFR，或两者兼有，代表着 LV 舒张功能障碍的风险增加。
