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.
Department of Cardiology, Liverpool Hospital, Sydney, New South Wales, Australia; Department of Cardiology, Campbelltown Hospital, Sydney, New South Wales, Australia.
J Am Soc Echocardiogr. 2021 Feb;34(2):166-175. doi: 10.1016/j.echo.2020.09.015. Epub 2020 Nov 20.
Patients with chronic kidney disease (CKD) are at increased risk of adverse cardiovascular events, which is underestimated by traditional risk stratification algorithms. We sought to determine clinical and echocardiographic predictors of adverse outcomes in CKD patients.
Two hundred forty-three prospectively recruited stage 3/4 CKD patients (male, 63%; mean age, 59.2 ± 14.4 years) without previous cardiac disease made up the study cohort. All participants underwent a transthoracic echocardiogram, with left ventricular (LV) and left atrial (LA) strain analysis. Participants were followed for 3.9 ± 2.7 years for the primary end point of cardiovascular death and major adverse cardiovascular event (MACE). The secondary end point was the composite of all-cause death and MACE.
Fifty-four patients met the primary end point, and 65 the secondary end point. On log-rank tests, older age, diabetes mellitus, anemia, greater LV mass, reduced LV global longitudinal strain, larger indexed LA volume, higher E/e' ratio, and reduced LA reservoir strain (LASr; P < .01 for all) were independent predictors of cardiovascular death and MACE. On multivariable regression analysis of univariate predictors, LASr (P < .01) was the only independent predictor for the primary end point as well as for the secondary end point. Receiver operating characteristic curve analysis showed LASr was a stronger predictor of adverse events (area under the curve [AUC] = 0.84) compared to the Framingham (AUC = 0.58) and Atherosclerotic Cardiovascular Disease (AUC = 0.59) risk scores.
LASr is an independent predictor of cardiovascular death and MACE in CKD patients, superior to clinical risk scores, LV parameters, and LA volume.
患有慢性肾脏病（CKD）的患者发生不良心血管事件的风险增加，而传统的风险分层算法对此估计不足。我们旨在确定 CKD 患者不良结局的临床和超声心动图预测因素。
本研究纳入了 243 例前瞻性招募的 3/4 期 CKD 患者（男性占 63%；平均年龄 59.2±14.4 岁），这些患者均无先前的心脏疾病。所有参与者均接受了经胸超声心动图检查，并进行了左心室（LV）和左心房（LA）应变分析。参与者随访 3.9±2.7 年，主要终点为心血管死亡和主要不良心血管事件（MACE）。次要终点为全因死亡和 MACE 的复合终点。
54 例患者达到了主要终点，65 例患者达到了次要终点。对数秩检验显示，年龄较大、糖尿病、贫血、LV 质量较大、LV 整体纵向应变降低、LA 指数容积较大、E/e'比值较高和 LA 储备应变（LASr）降低（所有 P<.01）与心血管死亡和 MACE 独立相关。对单变量预测因素进行多变量回归分析，LASr（P<.01）是主要终点和次要终点的唯一独立预测因素。受试者工作特征曲线分析显示，与 Framingham 风险评分（AUC=0.58）和动脉粥样硬化性心血管疾病（AUC=0.59）风险评分相比，LASr 对不良事件的预测能力更强（AUC=0.84）。
LASr 是 CKD 患者心血管死亡和 MACE 的独立预测因素，优于临床风险评分、LV 参数和 LA 容积。
