运动 E/e' 是慢性肾脏病患者运动能力和不良心血管结局的决定因素。
Exercise E/e' Is a Determinant of Exercise Capacity and Adverse Cardiovascular Outcomes in Chronic Kidney Disease.
机构信息
Department of Cardiology Blacktown Hospital, Sydney, New South Wales, Australia; Department of Cardiology Westmead Hospital, Sydney, New South Wales, Australia; University of New South Wales, Sydney, New South Wales, Australia.
University of New South Wales, Sydney, New South Wales, Australia; Department of Cardiology Liverpool Hospital, Sydney, New South Wales, Australia; Department of Cardiology Campbelltown Hospital, Sydney, New South Wales, Australia; Western Sydney University, Sydney, New South Wales, Australia.
出版信息
JACC Cardiovasc Imaging. 2020 Dec;13(12):2485-2494. doi: 10.1016/j.jcmg.2020.05.044. Epub 2020 Aug 26.
OBJECTIVES
This study sought to assess the relationship between E/e' and exercise capacity in patients with chronic kidney disease (CKD) and evaluate its prognostic role.
BACKGROUND
Patients with CKD have diastolic dysfunction, reduced physical fitness, and elevated risk of cardiovascular disease.
METHODS
Patients with stage 3 and 4 CKD without previous cardiac disease underwent resting and exercise stress echocardiograms with assessment of exercise E/e'. Patients were compared to age-, sex-, and risk factor-matched control individuals and were followed annually for 5 years for cardiovascular death and major adverse cardiovascular event(s) (MACE). Exercise capacity was assessed as metabolic equivalents (METs), with reduced exercise capacity defined as METs of ≤7. Raised exercise E/e' was defined as >13.
RESULTS
A total of 156 patients with CKD (age 62.8 ± 10.6 years; male: 62%) were compared to 156 matched control individuals. Patients with CKD were more likely to be anemic (p < 0.01) and had increased left ventricular mass (p < 0.01), larger left atrial volumes (p < 0.01), and higher resting (p < 0.01) and exercise E/e' (p < 0.01). Patients with CKD achieved lower exercise METs (p < 0.01), and more patients with CKD had METs of ≤7 (p < 0.01). Receiver-operating characteristic curves showed exercise E/e' (area under the curve [AUC]: 0.89; 95% CI: 0.84 to 0.95; p < 0.01) as the strongest predictor of reduced exercise capacity in patients with CKD. Over a follow-up period of 41.4 months, a raised exercise E/e' of >13 was an independent predictor of cardiovascular death and MACE on unadjusted and adjusted hazard models.
CONCLUSION
E/e' is a strong predictor of exercise capacity and METs achieved by patients with CKD. Exercise capacity was reduced in patients with CKD, presumably consequent to diastolic dysfunction. Elevated exercise E/e' in patients with CKD is an independent predictor of cardiovascular death and MACE.
目的
本研究旨在评估慢性肾脏病（CKD）患者的 E/e'与运动能力之间的关系，并评估其预后作用。
背景
CKD 患者存在舒张功能障碍、体力活动减少和心血管疾病风险增加。
方法
无既往心脏疾病的 CKD 3 期和 4 期患者接受静息和运动负荷超声心动图检查，评估运动时的 E/e'。将患者与年龄、性别和危险因素匹配的对照组进行比较，并在 5 年内每年随访，以评估心血管死亡和主要不良心血管事件（MACE）。运动能力以代谢当量（METs）评估，运动能力降低定义为 METs≤7。升高的运动 E/e'定义为>13。
结果
共比较了 156 例 CKD 患者（年龄 62.8±10.6 岁；男性占 62%）和 156 例匹配的对照组患者。CKD 患者更可能贫血（p<0.01），且左心室质量更大（p<0.01），左心房容积更大（p<0.01），静息时 E/e'更高（p<0.01），运动时 E/e'更高（p<0.01）。CKD 患者的运动 METs 更低（p<0.01），且有更多的 CKD 患者的 METs≤7（p<0.01）。受试者工作特征曲线显示，运动时的 E/e'（曲线下面积[AUC]：0.89；95%CI：0.84 至 0.95；p<0.01）是 CKD 患者运动能力降低的最强预测因子。在 41.4 个月的随访期间，升高的运动时 E/e'（>13）是未调整和调整后的危险模型中心血管死亡和 MACE 的独立预测因子。
结论
E/e'是 CKD 患者运动能力和 METs 的强有力预测因子。CKD 患者的运动能力降低，可能是由于舒张功能障碍所致。CKD 患者的运动时 E/e'升高是心血管死亡和 MACE 的独立预测因子。
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