Division of Nephrology, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC.
Nephron Clin Pract. 2013;123(1-2):52-60. doi: 10.1159/000351513. Epub 2013 Jun 11.
BACKGROUND/AIMS: Impaired left ventricular diastolic function and increased left ventricular filling pressure are frequently noted in patients with chronic kidney disease (CKD), even in early stages. The association of increased left ventricular filling pressure with cardiovascular and renal outcomes remains uncertain in CKD. This study is designed to assess whether the ratio of transmitral E-wave velocity (E) to early diastole mitral velocity (Ea) is associated with cardiovascular events and progression to dialysis in patients with CKD stages 3-5.
This longitudinal study enrolled 356 predialysis CKD patients. Cardiovascular events were defined as cardiovascular death, hospitalization for unstable angina, nonfatal myocardial infarction, ventricular tachycardia, hospitalization for congestive heart failure, transient ischemia attack, and stroke. The renal endpoint was defined as commencement of dialysis. The relative cardiovascular events and renal endpoints risks were analyzed by Cox regression methods.
The high E/Ea was independently associated with old age, cerebrovascular disease, congestive heart failure, high systolic blood pressure, hypertriglyceridemia, low hemoglobin, proteinuria, and worse echocardiographic profiles. Besides, the high E/Ea increased the risk of cardiovascular events (hazard ratio (HR) 1.067; 95% confidence interval (CI) 1.017-1.119; p = 0.008) and progression to dialysis (HR 1.042; 95% CI 1.000-1.085; p = 0.048).
Our study in patients of CKD stages 3-5 demonstrated the high E/Ea was associated with increased cardiovascular events and progression to dialysis. Assessment of the E/Ea by Doppler echocardiography is useful for predicting the risk of adverse cardiovascular and renal outcomes in CKD patients.
背景/目的：即使在慢性肾脏病（CKD）的早期阶段，患者也经常出现左心室舒张功能障碍和左心室充盈压升高。左心室充盈压升高与 CKD 患者心血管和肾脏结局的关系仍不确定。本研究旨在评估 3-5 期 CKD 患者的二尖瓣 E 波速度（E）与舒张早期二尖瓣速度（Ea）比值是否与心血管事件和进展至透析相关。
这项纵向研究纳入了 356 名透析前 CKD 患者。心血管事件定义为心血管死亡、不稳定型心绞痛住院、非致命性心肌梗死、室性心动过速、充血性心力衰竭住院、短暂性缺血发作和中风。肾脏终点定义为开始透析。采用 Cox 回归方法分析相对心血管事件和肾脏终点风险。
E/Ea 较高与年龄较大、脑血管疾病、充血性心力衰竭、收缩压较高、高三酰甘油血症、低血红蛋白、蛋白尿和较差的超声心动图特征独立相关。此外，E/Ea 较高增加了心血管事件的风险（危险比（HR）1.067；95%置信区间（CI）1.017-1.119；p = 0.008）和进展至透析的风险（HR 1.042；95% CI 1.000-1.085；p = 0.048）。
我们在 3-5 期 CKD 患者中的研究表明，E/Ea 较高与心血管事件增加和进展至透析相关。多普勒超声心动图评估 E/Ea 可用于预测 CKD 患者不良心血管和肾脏结局的风险。
