Cardiology Department, University Hospital of Wales, Cardiff, UK.
Cardiology Department, University Hospital of Wales, Cardiff, UK.
Int J Cardiol. 2018 Nov 15;271:274-280. doi: 10.1016/j.ijcard.2018.05.047. Epub 2018 May 17.
Metal-on-metal (MOM) hip prostheses have a higher failure rate than conventional prostheses and leaching of cobalt and chromium has been linked to cardiomyopathy. We screened MOM subjects to evaluate if cobalt and chromium are related to subclinical cardiac dysfunction.
A single centre, non-randomised, observational study using echocardiography in 95 patients who had undergone MOM hip prostheses, and 15 age matched controls with non-MOM hip replacement. Serial plasma cobalt and chromium levels were recorded, and data compared by tertiles of cobalt exposure.
Indexed left ventricular (LV) end-diastolic and end-systolic volumes (EDVi and ESVi) increased with tertile of cobalt (omnibus p = 0.003 for EDVi and ESVi), as did indexed left atrial (LA) volumes (p = 0.003). MOM subjects had 25% larger EDVi than controls, 32% larger ESVi (40 ml vs. 32 ml, and 15 ml vs. 11 ml, p = 0.003 for both) and 28% larger indexed LA (23 ml vs. 18 ml, p = 0.002). There were no differences in LV systolic or diastolic function, including ejection fraction, tissue velocity and mitral E/e'. Estimated glomerular filtration rate was 18% lower in the highest tertile compared with the lowest (p = 0.01) and correlated inversely with LA volume (r = -0.36, p < 0.001) and LV EDV (r = -0.24, p = 0.02).
No correlations between sensitive measures of systolic or diastolic cardiac function or serum cobalt/chromium levels were observed in this study. However, there was a relationship between increasing left ventricular and left atrial volumes and declining renal function with high cobalt levels which requires further evaluation in MOM patients.
金属对金属（MOM）髋关节假体的失败率高于传统假体，钴和铬的浸出与心肌病有关。我们对 MOM 受试者进行了筛选，以评估钴和铬是否与亚临床心功能障碍有关。
这是一项单中心、非随机、观察性研究，使用超声心动图对 95 例接受 MOM 髋关节假体的患者和 15 例年龄匹配的非 MOM 髋关节置换术患者进行评估。记录了连续的血浆钴和铬水平，并按钴暴露的三分位数进行了数据比较。
左心室（LV）舒张末期和收缩末期容积指数（EDVi 和 ESVi）随钴三分位数增加（EDVi 和 ESVi 的整体 p 值均为 0.003），左心房（LA）容积也增加（p 值均为 0.003）。MOM 组的 EDVi 比对照组大 25%，ESVi 大 32%（40ml 比 32ml，15ml 比 11ml，两者均 p=0.003），LA 指数大 28%（23ml 比 18ml，p=0.002）。LV 收缩和舒张功能，包括射血分数、组织速度和二尖瓣 E/e'，两组间无差异。与最低三分位相比，最高三分位的估算肾小球滤过率低 18%（p=0.01），与 LA 容积呈负相关（r=-0.36，p<0.001），与 LV EDV 呈负相关（r=-0.24，p=0.02）。
在本研究中，未观察到钴和铬水平与敏感的收缩或舒张心功能指标之间存在相关性。然而，在高钴水平下，LV 和 LA 容积增加与肾功能下降之间存在关联，这需要在 MOM 患者中进一步评估。
