Di Lullo L, Gorini A, Rivera R, De Pascalis A, Bellasi A, Russo D, Barbera V, Ronco C, Balducci A, Santoboni A
G Ital Nefrol. 2014 Nov-Dec;31(6).
Cardiovascular disease (CV) represents the main risk factor for morbidity and mortality in chronic kidney disease (CKD) patients. Large epidemiological studies have shown direct association between severity of CKD and CV event rates. Although patients with end-stage renal disease (ESRD), including dialysis ones, are at greater CV risk, cardiovascular involvement is already evident at the early stages of CKD. End-stage CKD is characterized conventional atherosclerotic risk factor but they cannot account for CV risk as reflected in high rates of sudden cardiac death, heart failure and myocardial infarction. Non-atherosclerotic processes, including left ventricular hypertrophy and fibrosis, mostly account for the excess risk of CV. Employment of cardiac magnetic resonance (CMR) in CKD has brought an improved understanding of the adverse CV changes, known as uremic cardiomyopathy. It is due to ability of cardiac magnetic resonance to provide a comprehensive non - invasive examination of cardiac structure and function, arterial function, myocardial tissue characterization (T1 mapping and inversion recovery imaging), and myocardial metabolic function (spectroscopy).
心血管疾病(CV)是慢性肾脏病(CKD)患者发病和死亡的主要危险因素。大型流行病学研究表明,CKD的严重程度与CV事件发生率之间存在直接关联。尽管终末期肾病(ESRD)患者,包括透析患者,心血管风险更高,但在CKD早期阶段心血管受累就已很明显。终末期CKD的特征是存在传统的动脉粥样硬化危险因素,但它们无法解释如心脏性猝死、心力衰竭和心肌梗死的高发生率所反映的CV风险。包括左心室肥厚和纤维化在内的非动脉粥样硬化过程,在很大程度上导致了CV额外风险。在CKD中使用心脏磁共振成像(CMR),使人们对称为尿毒症性心肌病的不良CV变化有了更好的理解。这是因为心脏磁共振成像能够对心脏结构和功能、动脉功能、心肌组织特征(T1映射和反转恢复成像)以及心肌代谢功能(光谱学)进行全面的非侵入性检查。