University of California, San Francisco/San Francisco Veterans Affairs Medical Center, San Francisco, California.
Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Clin J Am Soc Nephrol. 2017 Jan 6;12(1):60-68. doi: 10.2215/CJN.02700316. Epub 2016 Nov 10.
Heart failure is the most frequent cardiac complication of CKD. Left ventricular hypertrophy is common and develops early in CKD, but studies have not adequately evaluated the association of left ventricular mass index with heart failure incidence among men and women with CKD.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We evaluated echocardiograms of 2567 participants without self-reported heart failure enrolled in the Chronic Renal Insufficiency Cohort Study. Two-dimensional echocardiograms were performed at the year 1 study visit and interpreted at a central core laboratory. Left ventricular mass index was calculated using the linear method, indexed to height, and analyzed using sex-specific quartiles. The primary outcomes of incident heart failure and all-cause mortality were adjudicated over a median of 6.6 (interquartile range, 5.7-7.6) years.
Among 2567 participants, 45% were women, and 54% were nonwhite race; mean (SD) age was 59±11 years old, and mean eGFR was 44±17 ml/min per 1.73 m. During a median follow-up period of 6.6 years, 262 participants developed heart failure, and 470 participants died. Compared with participants in the first quartile of left ventricular mass index, those in the highest quartile had higher rates of incident heart failure (hazard ratio, 3.96; 95% confidence interval, 1.96 to 8.02) and mortality (hazard ratio, 1.86; 95% confidence interval, 1.22 to 2.85), even after adjustment for B-type natriuretic peptide, troponin T, mineral metabolism markers, and other cardiovascular disease risk factors. Those in the lowest quartile of ejection fraction had higher rates of incident heart failure (hazard ratio, 3.01; 95% confidence interval, 1.94 to 4.67) but similar mortality rates (hazard ratio, 1.18; 95% confidence interval, 0.89 to 1.57) compared with those in the highest quartile. Diastolic dysfunction was not significantly associated with heart failure or death.
Among persons with CKD and without history of cardiovascular disease, left ventricular mass index is strongly associated with incident heart failure, even after adjustment for major cardiovascular risk factors and biomarkers.
心力衰竭是 CKD 最常见的心脏并发症。左心室肥厚在 CKD 中很常见，且很早就会发生，但研究尚未充分评估左心室质量指数与 CKD 男性和女性心力衰竭发生率之间的关系。
设计、地点、参与者和测量方法：我们评估了 2567 名无心力衰竭自述史且参加慢性肾功能不全队列研究的参与者的超声心动图。二维超声心动图在研究的第 1 年就诊时进行，并在中心核心实验室进行解读。左心室质量指数采用线性方法计算，按身高指数化，并使用性别特异性四分位数进行分析。主要结局为事件性心力衰竭和全因死亡率，中位随访时间为 6.6 年（四分位距，5.7-7.6）。
在 2567 名参与者中，45%为女性，54%为非白人种族；平均（标准差）年龄为 59±11 岁，平均 eGFR 为 44±17 ml/min/1.73 m。在中位随访 6.6 年期间，262 名参与者发生心力衰竭，470 名参与者死亡。与左心室质量指数第 1 四分位的参与者相比，第 4 四分位的参与者心力衰竭的发生率更高（风险比，3.96；95%置信区间，1.96 至 8.02）和死亡率（风险比，1.86；95%置信区间，1.22 至 2.85），即使在调整 B 型利钠肽、肌钙蛋白 T、矿物质代谢标志物和其他心血管疾病风险因素后也是如此。射血分数最低四分位的参与者心力衰竭发生率更高（风险比，3.01；95%置信区间，1.94 至 4.67），但死亡率相似（风险比，1.18；95%置信区间，0.89 至 1.57）与最高四分位数相比。舒张功能障碍与心力衰竭或死亡无显著相关性。
在患有 CKD 且无心血管疾病病史的人群中，左心室质量指数与心力衰竭的发生密切相关，即使在调整了主要心血管风险因素和生物标志物后也是如此。
