慢性肾脏病合并高血压患者左心室肥厚及几何形态与不良结局的相关性

Associations of Left Ventricular Hypertrophy and Geometry with Adverse Outcomes in Patients with CKD and Hypertension.

作者信息

Paoletti Ernesto, De Nicola Luca, Gabbai Francis B, Chiodini Paolo, Ravera Maura, Pieracci Laura, Marre Sonia, Cassottana Paolo, Lucà Sergio, Vettoretti Simone, Borrelli Silvio, Conte Giuseppe, Minutolo Roberto

机构信息

Division of Nephrology, Dialysis and Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) University Hospital San Martino-Istituto Nazionale per la Ricerca sul Cancro (IST), University of Genoa, Genoa, Italy;

Division of Nephrology and.

出版信息

Clin J Am Soc Nephrol. 2016 Feb 5;11(2):271-9. doi: 10.2215/CJN.06980615. Epub 2015 Dec 14.

DOI:10.2215/CJN.06980615

PMID:26668021

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4741044/

Abstract

BACKGROUND AND OBJECTIVES

Left ventricular hypertrophy (LVH) and abnormal left ventricular (LV) geometry predict adverse outcomes in the general and hypertensive populations, but findings in CKD are still inconclusive.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We enrolled 445 patients with hypertension and CKD stages 2-5 in two academic nephrology clinics in 1999-2003 who underwent both echocardiography and ambulatory BP monitoring. LVH (LV mass >100 g/m(2) [women] and >131 g/m(2) [men]) and relative wall thickness (RWT) were used to define LV geometry: no LVH and RWT≤0.45 (normal), no LVH and RWT>0.45 (remodeling), LVH and RWT≤0.45 (eccentric), and LVH and RWT>0.45 (concentric). We evaluated the prognostic role of LVH and LV geometry on cardiovascular (CV; composite of fatal and nonfatal events) and renal outcomes (composite of ESRD and all-cause death).

RESULTS

Age was 64.1±13.8 years old; 19% had diabetes, and 22% had CV disease. eGFR was 39.9±20.2 ml/min per 1.73 m(2). LVH was detected in 249 patients (56.0%); of these, 125 had concentric LVH, and 124 had eccentric pattern, whereas 71 patients had concentric remodeling. Age, women, anemia, and nocturnal hypertension were independently associated with both concentric and eccentric LVH, whereas diabetes and history of CV disease associated with eccentric LVH only, and CKD stages 4 and 5 associated with concentric LVH only. During follow-up (median, 5.9 years; range, 0.04-15.3), 188 renal deaths (112 ESRD) and 103 CV events (61 fatal) occurred. Using multivariable Cox analysis, concentric and eccentric LVH was associated with higher risk of CV outcomes (hazard ratio [HR], 2.59; 95% confidence interval [95% CI], 1.39 to 4.84 and HR, 2.79; 95% CI, 1.47 to 5.26, respectively). Similarly, greater risk of renal end point was detected in concentric (HR, 2.33; 95% CI, 1.44 to 3.80) and eccentric (HR, 2.30; 95% CI, 1.42 to 3.74) LVH. Sensitivity analysis using LVH and RWT separately showed that LVH but not RWT was associated with higher cardiorenal risk.

CONCLUSIONS

In patients with CKD, LVH is a strong predictor of the risk of poor CV and renal outcomes independent from LV geometry.

摘要

背景与目的

左心室肥厚（LVH）和左心室（LV）几何形态异常可预测普通人群和高血压人群的不良结局，但在慢性肾脏病（CKD）中的研究结果仍不明确。

设计、地点、参与者及测量方法：1999年至2003年，我们在两家学术性肾脏病诊所招募了445例2 - 5期高血压合并CKD患者，这些患者均接受了超声心动图检查和动态血压监测。采用LVH（左心室质量>100 g/m²[女性]和>131 g/m²[男性]）和相对室壁厚度（RWT）来定义左心室几何形态：无LVH且RWT≤0.45（正常），无LVH且RWT>0.45（重塑），LVH且RWT≤0.45（离心性），以及LVH且RWT>0.45（向心性）。我们评估了LVH和左心室几何形态对心血管（CV；致命和非致命事件的综合）和肾脏结局（终末期肾病[ESRD]和全因死亡的综合）的预后作用。

结果

年龄为64.1±13.8岁；19%患有糖尿病，22%患有心血管疾病。估算肾小球滤过率（eGFR）为39.9±20.2 ml/min/1.73 m²。249例患者（56.0%）检测到LVH；其中，125例为向心性LVH，124例为离心性模式，而71例患者为向心性重塑。年龄、女性、贫血和夜间高血压与向心性和离心性LVH均独立相关，而糖尿病和心血管疾病史仅与离心性LVH相关，CKD 4期和5期仅与向心性LVH相关。在随访期间（中位数为5.9年；范围为0.04 - 15.3年），发生了188例肾脏死亡（112例ESRD）和103例心血管事件（61例致命）。使用多变量Cox分析，向心性和离心性LVH与心血管结局风险较高相关（风险比[HR]分别为2.59；95%置信区间[95%CI]为1.39至4.84和HR为2.79；95%CI为1.47至5.26）。同样，在向心性（HR为2.33；95%CI为1.44至3.80）和离心性（HR为2.30；95%CI为1.42至3.74）LVH中检测到肾脏终点风险更高。使用LVH和RWT分别进行的敏感性分析表明，LVH而非RWT与更高的心肾风险相关。