Bosselmann Helle, Tonder Niels, Sölétormos György, Rossing Kasper, Iversen Kasper, Goetze Jens P, Gustafsson Finn, Schou Morten
Department of Cardio-, Nephro- and Endocrinology, North Zealand Hospital, University of Copenhagen, Denmark.
Department of Cardio-, Nephro- and Endocrinology, North Zealand Hospital, University of Copenhagen, Denmark.
Int J Cardiol. 2014 Dec 20;177(3):942-8. doi: 10.1016/j.ijcard.2014.09.202. Epub 2014 Oct 7.
Renal dysfunction (RD) is associated with poor outcome in systolic heart failure (HF). Left ventricular ejection fraction (LVEF) is not depressed to a greater extent in patients with RD compared to patients with normal renal function, but it is relatively unknown whether other measures of myocardial function are impaired by RD. The objective of the present study is to evaluate whether RD in systolic HF is associated with excessive impairment of myocardial function, evaluated by strain analysis and cardiac biomarkers.
Patients with LVEF <0.45% were enrolled from an outpatient HF clinic. The patients underwent advanced echocardiography. Glomerular filtration rate was estimated by the CKD-EPI equation (eGFR) and patients grouped by eGFR: eGFR group-I, ≥ 90 ml/min/1.73 m(2); eGFR group-II, 60-89 ml/min/1.73 m(2); and eGFR group-III, ≤ 59 ml/min/1.73 m(2). Multivariate regression models were developed to evaluate the associations between eGFR groups, echocardiographic measures and cardiac biomarkers.
A total of 149 patients participated in the study. Median age was 69 years, 26% were female; LVEF was 33%. Patients with a low eGFR were older (P < 0.001), but there were no differences in frequency of atrial fibrillation, hypertension, diabetes and ischemic heart disease between eGFR groups (P > 0.05 for all). RD was associated with impaired global longitudinal strain (P = 0.018), increased E/e' (P = 0.032), larger left atria (P = 0.038) and increased levels of proANP (P < 0.001), NT-proBNP (P < 0.001) and troponin I (P = 0.019) after adjustment for traditional confounders.
Echocardiographic measures and biomarkers reflecting different aspects of myocardial function are impaired in systolic HF patients with RD and the increased mortality risk in these patients may partly be explained by a depressed cardiac function.
肾功能不全（RD）与收缩性心力衰竭（HF）的不良预后相关。与肾功能正常的患者相比，RD患者的左心室射血分数（LVEF）降低程度并不更大，但RD是否会损害心肌功能的其他指标尚不清楚。本研究的目的是评估收缩性HF中的RD是否与心肌功能的过度损害相关，通过应变分析和心脏生物标志物进行评估。
从门诊HF诊所招募LVEF<0.45%的患者。患者接受了高级超声心动图检查。通过CKD-EPI方程（eGFR）估算肾小球滤过率，并根据eGFR对患者进行分组：eGFR I组，≥90 ml/min/1.73 m²；eGFR II组，60-89 ml/min/1.73 m²；eGFR III组，≤59 ml/min/1.73 m²。建立多变量回归模型以评估eGFR组、超声心动图测量值和心脏生物标志物之间的关联。
共有149名患者参与研究。中位年龄为69岁，26%为女性；LVEF为33%。eGFR低的患者年龄较大（P<0.001），但eGFR组之间房颤、高血压、糖尿病和缺血性心脏病的发生率无差异（所有P>0.05）。在调整传统混杂因素后，RD与整体纵向应变受损（P=0.018）、E/e'升高（P=0.032）、左心房增大（P=0.038）以及proANP（P<0.001）、NT-proBNP（P<0.001）和肌钙蛋白I水平升高（P=0.019）相关。
在患有RD的收缩性HF患者中，反映心肌功能不同方面的超声心动图测量值和生物标志物受损，这些患者死亡风险增加可能部分归因于心脏功能降低。
