Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong; and Department of Echocardiography, Cardiovascular Institute and Fu Wai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Department of Echocardiography, Cardiovascular Institute and Fu Wai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
J Am Soc Nephrol. 2014 Jul;25(7):1599-608. doi: 10.1681/ASN.2013080899. Epub 2014 Feb 13.
Little is known regarding the natural longitudinal changes in cardiac structure and function in CKD. We hypothesized that baseline CKD stage is associated with progressive worsening in cardiac structure and function. We conducted a prospective longitudinal study, recruiting 300 patients with stages 3-5 CKD from a major regional tertiary center and university teaching hospital in Hong Kong. Baseline CKD stages were studied in relation to natural longitudinal changes in echocardiographic and tissue Doppler imaging-derived parameters. Over 1 year, the prevalence of left ventricular (LV) hypertrophy increased from 40.3% to 48.9%, median left atrial volume index increased 4.8 (interquartile range [IQR], 2.1, 7.7) ml/m(2) (P<0.001), peak systolic mitral annular velocity decreased 0.5 (IQR, -1.5, 0.5) cm/s (P<0.001), early diastolic mitral annular velocity decreased 0.5 (IQR, -1.5, 0.5) cm/s (P<0.001), and eGFR declined 2.0 (IQR, -5.0, 0.0) ml/min per 1.73 m(2). CKD stages 4 and 5 were associated with more baseline abnormalities in cardiac structure and function and predicted greater longitudinal progression in LV mass index (odds ratio [OR], 3.02; 95% confidence interval [95% CI], 1.39 to 6.58), volume index (OR, 2.58; 95% CI, 1.18 to 5.62), and left atrial volume index (OR, 2.61; 95% CI, 1.20 to 5.69) and worse diastolic dysfunction grade (OR, 3.17; 95% CI, 1.16 to 8.69) compared with stage 3a in the fully adjusted analysis. In conclusion, more advanced CKD at baseline may be associated with larger longitudinal increases in LV mass and volume and greater deterioration in diastolic function.
关于慢性肾脏病（CKD）患者心脏结构和功能的自然纵向变化，人们知之甚少。我们假设，基线 CKD 分期与心脏结构和功能的进行性恶化有关。我们进行了一项前瞻性纵向研究，从香港一家主要的区域三级中心和大学教学医院招募了 300 名 CKD 3-5 期患者。研究了基线 CKD 分期与超声心动图和组织多普勒成像衍生参数的自然纵向变化之间的关系。在 1 年期间，左心室（LV）肥厚的患病率从 40.3%增加到 48.9%，中位数左心房容积指数增加了 4.8（四分位距 [IQR]，2.1，7.7）ml/m2（P<0.001），收缩期二尖瓣环速度峰值降低了 0.5（IQR，-1.5，0.5）cm/s（P<0.001），舒张早期二尖瓣环速度降低了 0.5（IQR，-1.5，0.5）cm/s（P<0.001），eGFR 下降了 2.0（IQR，-5.0，0.0）ml/min per 1.73 m2。CKD 4 期和 5 期与心脏结构和功能的基线异常更多有关，并且预测 LV 质量指数（优势比 [OR]，3.02；95%置信区间 [95%CI]，1.39 至 6.58）、容积指数（OR，2.58；95%CI，1.18 至 5.62）和左心房容积指数（OR，2.61；95%CI，1.20 至 5.69）以及舒张功能障碍程度恶化（OR，3.17；95%CI，1.16 至 8.69）较 3a 期更大的纵向进展。总之，基线时更严重的 CKD 可能与 LV 质量和容积的更大纵向增加以及舒张功能的恶化有关。
