Department of Internal Diseases, Gastroenterology and Hepatology, University Clinical Hospital in Olsztyn, Poland; Department of Internal Diseases, Gastroenterology, Cardiology and Infectiology, University of Warmia and Mazury in Olsztyn, Poland.
Department of Internal Diseases, Gastroenterology, Cardiology and Infectiology, University of Warmia and Mazury in Olsztyn, Poland.
J Cardiol. 2014 Mar;63(3):198-204. doi: 10.1016/j.jjcc.2013.08.003. Epub 2013 Sep 4.
Left ventricular (LV) diastolic dysfunction in patients with chronic kidney disease (CKD) is of a complex nature and is the predominant cause of congestive heart failure in this group of patients. This work aimed to evaluate the potential effect of disturbances in calcium-phosphorus (Ca-P) metabolism in patients with CKD on LV diastolic function as assessed by echocardiography.
The study group consisted of 81 ambulatory patients with CKD, stages 2-5, with preserved LV systolic function-LV ejection fraction >50% and with sinus rhythm. Standard echocardiography was performed in all patients with tissue Doppler echocardiography for the evaluation of the systolic velocity and both diastolic velocities of LV (EmLV and AmLV). The following laboratory parameters were measured: serum creatinine concentration, estimated glomerular filtration rate, and the levels of urea, P, Ca, parathormone, platelet count, hemoglobin level, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels. Patients were divided into two groups according to the results of EmLV: group with LV diastolic dysfunction (EmLV<8cm/s) DF (+) and group with normal LV diastolic function DF (-), when EmLV was ≥8cm/s.
Patients in DF (+) group, as compared to DF (-) patients, manifested a lower serum Ca level and an elevated NT-proBNP level [9.03±0.76mg/dL vs 9.44±0.78mg/dL, p=0.02, and 257.9 (32.6-12,633)pg/ml vs 149 (11.7-966)pg/ml, p=0.035, respectively]. The area under the receiver operating characteristics (ROC) curve of Ca for diastolic dysfunction was 0.627, 95% CI (0.511-0.734), p=0.04, whereas ROC derived Ca value of ≤9.82mg/dL was characterized by a sensitivity of 91.8% and specificity of 38.1% for diagnosing LV diastolic dysfunction. The only independent variable predicting LV diastolic dysfunction as measured by a multivariate logistic regression analysis was Ca level≤9.82mg/dL with odds ratio=8.81 (95% CI 1.49-51.82), p=0.014.
Hypocalcemia is an independent predictive factor for LV diastolic dysfunction in patients with CKD.
慢性肾脏病（CKD）患者的左心室（LV）舒张功能障碍具有复杂性，是该组患者充血性心力衰竭的主要原因。本研究旨在评估 CKD 患者钙磷（Ca-P）代谢紊乱对超声心动图评估的 LV 舒张功能的潜在影响。
该研究组包括 81 名患有 CKD 的门诊患者，分期 2-5 期，LV 收缩功能正常 -LV 射血分数>50%，且窦性节律。对所有患者进行标准超声心动图检查和组织多普勒超声心动图评估，以评估 LV 的收缩速度和舒张速度（EmLV 和 AmLV）。测量了以下实验室参数：血清肌酐浓度、估算肾小球滤过率以及尿素、磷、钙、甲状旁腺激素、血小板计数、血红蛋白水平和 N 端脑钠肽前体（NT-proBNP）水平。根据 EmLV 的结果，将患者分为两组：EmLV<8cm/s 的左心室舒张功能障碍（DF(+)）组和 EmLV≥8cm/s 的正常左心室舒张功能（DF(-)）组。
与 DF(-)患者相比，DF(+)患者的血清 Ca 水平较低，NT-proBNP 水平较高[9.03±0.76mg/dL vs 9.44±0.78mg/dL，p=0.02，257.9(32.6-12,633)pg/ml vs 149(11.7-966)pg/ml，p=0.035]。Ca 对舒张功能障碍的受试者工作特征（ROC）曲线下面积为 0.627，95%置信区间（0.511-0.734），p=0.04，而 ROC 得出的 Ca 值≤9.82mg/dL 时，诊断 LV 舒张功能障碍的敏感性为 91.8%，特异性为 38.1%。多元逻辑回归分析表明，唯一预测 LV 舒张功能障碍的独立变量是 Ca 值≤9.82mg/dL，优势比=8.81（95%置信区间 1.49-51.82），p=0.014。
低钙血症是 CKD 患者 LV 舒张功能障碍的独立预测因素。
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