Department of Medicine I, University Hospital of Würzburg, Würzburg, Germany.
Department of Paediatrics, University Hospital of Erlangen, Loschgestraße 15, 91054, Erlangen, Germany.
Cardiovasc Ultrasound. 2020 Sep 16;18(1):39. doi: 10.1186/s12947-020-00217-y.
Left ventricular hypertrophy (LVH), defined by the left ventricular mass index (LVMI), is highly prevalent in hemodialysis patients and a strong independent predictor of cardiovascular events. Compared to cardiac magnetic resonance imaging (CMR), echocardiography tends to overestimate the LVMI. Here, we evaluate the diagnostic performance of transthoracic echocardiography (TTE) compared to CMR regarding the assessment of LVMI in hemodialysis patients.
TTR and CMR data for 95 hemodialysis patients who participated in the MiREnDa trial were analyzed. The LVMI was calculated by two-dimensional (2D) TTE-guided M-mode measurements employing the American Society of Echocardiography (ASE) and Teichholz (Th) formulas, which were compared to the reference method, CMR.
LVH was present in 44% of patients based on LVMI measured by CMR. LVMI measured by echocardiography correlated moderately with CMR, ASE: r = 0.44 (0.34-0.62); Th: r = 0.44 (0.32-0.62). Compared to CMR, both echocardiographic formulas overestimated LVMI (mean ∆LVMI (ASE-CMR): 19.5 ± 19.48 g/m, p < 0.001; mean ∆LVMI (Th-CMR): 15.9 ± 15.89 g/m, p < 0.001). We found greater LVMI overestimation in patients with LVH using the ASE formula compared to the Th formula. Stratification of patients into CMR LVMI quartiles showed a continuous decrease in ∆LVMI with increasing CMR LVMI quartiles for the Th formula (p < 0.001) but not for the ASE formula (p = 0.772). Bland-Altman analysis showed that the Th formula had a constant bias independent of LVMI. Both methods had good discrimination ability for the detection of LVH (ROC-AUC: 0.819 (0.737-0.901) and 0.808 (0.723-0.892) for Th and ASE, respectively).
The ASE and Th formulas overestimate LVMI in hemodialysis patients. However, the overestimation is less with the Th formula, particularly with increasing LVMI. The results suggest that the Th formula should be preferred for measurement of LVMI in chronic hemodialysis patients.
The data was derived from the following clinical trial: NCT01691053 , registered on 19 September 2012 before enrollment of the first participant.
左心室肥厚（LVH）通过左心室质量指数（LVMI）定义，在血液透析患者中非常普遍，是心血管事件的一个强有力的独立预测因子。与心脏磁共振成像（CMR）相比，超声心动图往往会高估 LVMI。在这里，我们评估了经胸超声心动图（TTE）与 CMR 相比在血液透析患者中评估 LVMI 的诊断性能。
分析了 95 名参加 MiREnDa 试验的血液透析患者的 TTR 和 CMR 数据。通过二维（2D）TTE 引导的 M 模式测量，使用美国超声心动图学会（ASE）和 Teichholz（Th）公式计算 LVMI，并与参考方法 CMR 进行比较。
根据 CMR 测量的 LVMI，44%的患者存在 LVH。超声心动图测量的 LVMI 与 CMR 中度相关，ASE：r=0.44（0.34-0.62）；Th：r=0.44（0.32-0.62）。与 CMR 相比，两种超声心动图公式均高估了 LVMI（ASE-CMR 平均差异 LVMI：19.5±19.48 g/m，p<0.001；Th-CMR 平均差异 LVMI：15.9±15.89 g/m，p<0.001）。我们发现，与 Th 公式相比，ASE 公式在 LVH 患者中高估 LVMI 的程度更大。根据 CMR 的 LVMI 四分位数对患者进行分层显示，随着 Th 公式的 CMR LVMI 四分位数的增加，LVMI 的差异呈连续下降（p<0.001），但 ASE 公式无此趋势（p=0.772）。Bland-Altman 分析表明，Th 公式具有独立于 LVMI 的恒定偏差。两种方法均具有良好的鉴别能力，可检测 LVH（ROC-AUC：Th 为 0.819（0.737-0.901），ASE 为 0.808（0.723-0.892））。
ASE 和 Th 公式高估了血液透析患者的 LVMI。然而，Th 公式的高估程度较小，特别是随着 LVMI 的增加。结果表明，在慢性血液透析患者中测量 LVMI 时，应首选 Th 公式。
该数据来自以下临床试验：NCT01691053，于 2012 年 9 月 19 日在第一位参与者入组前注册。
