Kovács Attila, Tapolyai Mihály, Celeng Csilla, Gara Edit, Faludi Mária, Berta Klára, Apor Astrid, Nagy Andrea, Tislér András, Merkely Béla
Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, Budapest, 1122, Hungary,
Int J Cardiovasc Imaging. 2014 Oct;30(7):1331-7. doi: 10.1007/s10554-014-0480-2. Epub 2014 Jul 8.
Left ventricular (LV) hypertrophy and one of its inducers, the fibroblast growth factor-23 (FGF-23) were found to be associated with unfavourable outcome in end-stage renal disease (ESRD) patients. We sought to investigate the influence of hemodialysis (HD), increased LV mass and FGF-23 on LV mechanics using three-dimensional (3D) speckle tracking echocardiography. Forty-four ESRD patients on maintenance HD were examined just before and immediately after HD, and were compared to 44 normal controls (NC). Transthoracic 3D recordings were obtained using multi-beat reconstruction from 6 consecutive cardiac cycles. LV mass index (LVMi) was evaluated and 3D speckle tracking analysis was performed to calculate global longitudinal (GLS), circumferential (GCS), area (GAS) and radial (GRS) peak systolic strain. Serum FGF-23 levels were also measured. Strain values improved in all directions after HD [pre- vs. post-HD; GLS: -20(3) vs. -21(6), GCS: -20(4) vs. -22(7), GAS: -33(5) vs. -35(10), GRS: 50(12) vs. 53.5(20) %, all p < 0.01]. LVMi was remarkably increased in our patients [ESRD vs. NC; 136(46) vs. 71(8) g/m(2), p < 0.001]. Elevated FGF-23 levels were associated with increased LV mass (ρ = 0.581, p < 0.001). LVMi was inversely related to pre-HD GCS (ρ = 0.626, p < 0.001) and post-HD GCS (ρ = 0.761, p < 0.001), GAS (ρ = 0.534, p < 0.05) and GRS (ρ = -0.639, p < 0.01). Serum FGF-23 levels correlated with post-HD GAS (ρ = 0.513, p < 0.01) and GRS (ρ = -0.512, p < 0.05). HD treatment results in immediate improvement in all strain directions. Besides inducing LV hypertrophy, FGF-23 may play a role in the deterioration of LV mechanics in patients with ESRD.
左心室（LV）肥厚及其诱导因子之一成纤维细胞生长因子-23（FGF-23）被发现与终末期肾病（ESRD）患者的不良预后相关。我们试图使用三维（3D）斑点追踪超声心动图研究血液透析（HD）、左心室质量增加和FGF-23对左心室力学的影响。对44例维持性血液透析的ESRD患者在透析前和透析后立即进行检查，并与44例正常对照（NC）进行比较。使用来自6个连续心动周期的多搏重建获得经胸3D记录。评估左心室质量指数（LVMi）并进行3D斑点追踪分析以计算整体纵向（GLS）、圆周（GCS）、面积（GAS）和径向（GRS）收缩期峰值应变。还测量了血清FGF-23水平。透析后所有方向的应变值均有所改善[透析前与透析后；GLS：-20（3）对-21（6），GCS：-20（4）对-22（7），GAS：-33（5）对-35（10），GRS：50（12）对53.5（20）%，所有p<0.01]。我们的患者左心室质量指数显著增加[ESRD与NC；136（46）对71（8）g/m²，p<0.001]。FGF-23水平升高与左心室质量增加相关（ρ=0.581，p<0.001）。左心室质量指数与透析前GCS（ρ=0.626，p<0.001）、透析后GCS（ρ=0.761，p<0.001）、GAS（ρ=0.534，p<0.05）和GRS（ρ=-0.639，p<0.01）呈负相关。血清FGF-23水平与透析后GAS（ρ=0.513，p<0.01）和GRS（ρ=-0.512，p<0.05）相关。血液透析治疗可使所有应变方向立即得到改善。除了诱导左心室肥厚外，FGF-23可能在ESRD患者左心室力学恶化中起作用。
