Kramann Rafael, Erpenbeck Johanna, Schneider Rebekka K, Röhl Anna B, Hein Marc, Brandenburg Vincent M, van Diepen Merel, Dekker Friedo, Marx Nicolaus, Floege Jürgen, Becker Michael, Schlieper Georg
Division of Nephrology and Clinical Immunology,
Division of Nephrology and Clinical Immunology.
J Am Soc Nephrol. 2014 Oct;25(10):2351-65. doi: 10.1681/ASN.2013070734. Epub 2014 Apr 3.
Cardiovascular mortality is high in ESRD, partly driven by sudden cardiac death and recurrent heart failure due to uremic cardiomyopathy. We investigated whether speckle-tracking echocardiography is superior to routine echocardiography in early detection of uremic cardiomyopathy in animal models and whether it predicts cardiovascular mortality in patients undergoing dialysis. Using speckle-tracking echocardiography in two rat models of uremic cardiomyopathy soon (4-6 weeks) after induction of kidney disease, we observed that global radial and circumferential strain parameters decreased significantly in both models compared with controls, whereas standard echocardiographic readouts, including fractional shortening and cardiac output, remained unchanged. Furthermore, strain parameters showed better correlations with histologic hallmarks of uremic cardiomyopathy. We then assessed echocardiographic and clinical characteristics in 171 dialysis patients. During the 2.5-year follow-up period, ejection fraction and various strain parameters were significant risk factors for cardiovascular mortality (primary end point) in a multivariate Cox model (ejection fraction hazard ratio [HR], 0.97 [95% confidence interval (95% CI), 0.95 to 0.99; P=0.012]; peak global longitudinal strain HR, 1.17 [95% CI, 1.07 to 1.28; P<0.001]; peak systolic and late diastolic longitudinal strain rates HRs, 4.7 [95% CI, 1.23 to 17.64; P=0.023] and 0.25 [95% CI, 0.08 to 0.79; P=0.02], respectively). Multivariate Cox regression analysis revealed circumferential early diastolic strain rate, among others, as an independent risk factor for all-cause mortality (secondary end point; HR, 0.43; 95% CI, 0.25 to 0.74; P=0.002). Together, these data support speckle tracking as a postprocessing echocardiographic technique to detect uremic cardiomyopathy and predict cardiovascular mortality in ESRD.
终末期肾病（ESRD）患者的心血管死亡率很高，部分原因是心源性猝死和尿毒症性心肌病导致的反复心力衰竭。我们研究了斑点追踪超声心动图在动物模型中早期检测尿毒症性心肌病方面是否优于常规超声心动图，以及它是否能预测接受透析患者的心血管死亡率。在肾病诱导后不久（4 - 6周），我们在两种尿毒症性心肌病大鼠模型中使用斑点追踪超声心动图，观察到与对照组相比，两种模型的整体径向和圆周应变参数均显著降低，而包括缩短分数和心输出量在内的标准超声心动图读数保持不变。此外，应变参数与尿毒症性心肌病的组织学特征具有更好的相关性。然后，我们评估了171例透析患者的超声心动图和临床特征。在2.5年的随访期内，射血分数和各种应变参数是多变量Cox模型中心血管死亡率（主要终点）的显著危险因素（射血分数风险比[HR]，0.97[95%置信区间（95%CI），0.95至0.99；P = 0.012]；整体纵向应变峰值HR，1.17[95%CI，1.07至1.28；P < 0.001]；收缩期峰值和舒张晚期纵向应变率HR分别为4.7[95%CI，1.23至17.64；P = 0.023]和0.25[95%CI，0.08至0.79；P = 0.02]）。多变量Cox回归分析显示，圆周舒张早期应变率是全因死亡率（次要终点）的独立危险因素之一（HR，0.43；95%CI，0.25至0.74；P = 0.002）。总之，这些数据支持将斑点追踪作为一种超声心动图后处理技术，用于检测尿毒症性心肌病并预测ESRD患者的心血管死亡率。
