Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersens vej 65, DK-2900, Post 835, Copenhagen, Denmark.
Division of Cardiology, University of California, San Francisco (UCSF), 505 Parnassus Ave, San Francisco, CA, 94143, USA.
BMC Nephrol. 2019 Aug 16;20(1):324. doi: 10.1186/s12882-019-1500-1.
Patients with autosomal dominant polycystic kidney disease (ADPKD) have an increased risk of cardiovascular morbidity and mortality. Impaired left ventricular (LV) global longitudinal strain (GLS) can be a sign of subclinical cardiac dysfunction even in patients with otherwise preserved ejection fraction (EF). Transmitral early filling velocity to early diastolic strain rate (E/SRe) is a novel measure of LV filling pressure, which is often affected early in cardiac disease.
A total of 110 ADPKD patients not on dialysis were included in this prospective study. All patients underwent an extensive echocardiographic examination including two-dimensional speckle tracking. GLS and strain rates were measured. The distribution of GLS and E/SRe was determined and patient characteristics were compared by median levels of GLS (- 17.8%) and E/SRe (91.4 cm). Twenty healthy participants were included as control group.
There was a significantly worse GLS in the ADPKD patients (mean: - 17.8 ± 2.5%) compared to the healthy controls (mean: - 21.9 ± 1.9%), p < 0.001. The same was true for E/SRe (mean: 10.0 ± 0.3 cm) compared to the control group (mean: 6.5 ± 0.3 cm), p < 0.001. In simple logistic regression, male gender (OR: 4.74 [2.10-10.71], p < 0.001), fasting glucose (odds ratio (OR) 1.05 [1.01-1.10], p = 0.024), htTKV (OR: 1.07 [1.01-1.13], p = 0.013), HDL cholesterol (OR: 0.97 [0.94, 0.996], p = 0.025), triglycerides (OR: 1.01 [1.00-1.02], p = 0.039), hemoglobin (OR: 1.50 [1.11-2.04], p = 0.009), and β-blocker use (OR: 1.07 [1.01, 1.13], p = 0.013) were all associated with higher GLS. After multivariate logistic regression with backward model selection, only male gender (OR: 5.78 [2.27-14.71], p < 0.001) and β-blocker use (OR: 14.00 [1.60, 122.51], p = 0.017) remained significant. In simple logistic regression models, BMI (OR: 1.11 [1.02-1.20], p = 0.015), systolic blood pressure (OR: 1.03 [1.00-1.06], p = 0.027) and β-blocker use (OR: 17.12 [2.15-136.20], p = 0.007) were associated with higher E/SRe - a novel measure of left ventricular filling pressure. After backward elimination, only β-blocker use (OR: 17.22 [2.16, 137.14], p = 0.007) remained significant.
Higher GLS and E/SRe are common in ADPKD patients, even in patients with preserved eGFR and normal left ventricular EF. GLS and E/SRe may aid in cardiovascular risk stratification in patients with ADPKD as they represent early markers of cardiac dysfunction.
常染色体显性多囊肾病（ADPKD）患者心血管发病率和死亡率增加。即使射血分数（EF）正常的患者，左心室（LV）整体纵向应变（GLS）降低也可能是亚临床心功能障碍的迹象。二尖瓣早期充盈速度与早期舒张应变率（E/SRe）是 LV 充盈压的一种新的测量方法，在心脏疾病早期往往会受到影响。
本前瞻性研究纳入了 110 名未接受透析的 ADPKD 患者。所有患者均接受了包括二维斑点追踪在内的广泛超声心动图检查。测量 GLS 和应变率。通过 GLS（-17.8%）和 E/SRe（91.4cm）的中位数水平确定 GLS 和 E/SRe 的分布，并比较患者特征。20 名健康参与者作为对照组。
与健康对照组（平均：-21.9±1.9%）相比，ADPKD 患者的 GLS 明显更差（平均：-17.8±2.5%），p<0.001。E/SRe 也是如此（平均：10.0±0.3cm）与对照组（平均：6.5±0.3cm）相比，p<0.001。在简单的逻辑回归中，男性（OR：4.74[2.10-10.71]，p<0.001）、空腹血糖（比值比（OR）1.05[1.01-1.10]，p=0.024）、htTKV（OR：1.07[1.01-1.13]，p=0.013）、高密度脂蛋白胆固醇（OR：0.97[0.94-0.996]，p=0.025）、甘油三酯（OR：1.01[1.00-1.02]，p=0.039）、血红蛋白（OR：1.50[1.11-2.04]，p=0.009）和β受体阻滞剂的使用（OR：1.07[1.01-1.13]，p=0.013）均与较高的 GLS 相关。多元逻辑回归后，只有男性（OR：5.78[2.27-14.71]，p<0.001）和β受体阻滞剂的使用（OR：14.00[1.60-122.51]，p=0.017）仍有统计学意义。在简单的逻辑回归模型中，BMI（OR：1.11[1.02-1.20]，p=0.015）、收缩压（OR：1.03[1.00-1.06]，p=0.027）和β受体阻滞剂的使用（OR：17.12[2.15-136.20]，p=0.007）与较高的 E/SRe（一种新的左心室充盈压测量方法）相关。向后消除后，只有β受体阻滞剂的使用（OR：17.22[2.16, 137.14]，p=0.007）仍有统计学意义。
即使在 eGFR 正常和左心室 EF 正常的患者中，ADPKD 患者的 GLS 和 E/SRe 也很常见。GLS 和 E/SRe 可能有助于 ADPKD 患者的心血管风险分层，因为它们是心功能障碍的早期标志物。
