Division of Pediatric Nephrology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA.
Division of Nephrology, Kidney Research Institute, University of Washington, Seattle, WA, USA.
Nephrol Dial Transplant. 2021 Dec 2;36(12):2282-2289. doi: 10.1093/ndt/gfaa296.
Among patients with chronic kidney disease (CKD), the circulating cardiac biomarkers soluble ST2 (SST2), galectin-3, growth differentiation factor-15 (GDF-15), N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity troponin-T (hsTnT) possibly reflect pathophysiologic processes and are associated with clinical cardiovascular disease. Whether these biomarkers are associated with electrocardiographic findings is not known. The aim of this study was to test the association between serum cardiac biomarkers and the presence of electrocardiographic changes potentially indicative of subclinical myocardial disease in patients with CKD.
We performed a cross-sectional analysis using 3048 participants from the Chronic Renal Insufficiency Cohort (CRIC) without atrial fibrillation, atrioventricular block, bundle branch block or a pacemaker at the baseline visit. Using logistic regression, we tested the association of each of the five cardiac biomarkers with baseline electrocardiogram (ECG) findings: PR interval >200 ms, QRS interval >100 ms and a prolonged QTc interval. Models were adjusted for demographic variables, measures of kidney function, prevalent cardiovascular disease and cardiovascular risk factors.
In adjusted models, hsTnT levels associated with prolonged PR {odds ratio [OR] 1.23 [95% confidence interval (CI) 1.08-1.40]}, QRS [OR 1.28 (95% CI 1.16-1.42)] and QTc [OR 1.94 (95% CI 1.50-2.51)] intervals. NT-proBNP levels were associated with prolonged QRS [OR 1.11 (95% CI 1.06-1.16)] and QTc [OR 1.82 (95% CI 1.58-2.10)] intervals. SST2, galectin-3 and GDF-15 were not significantly associated with any of the ECG parameters.
hsTnT and NT-proBNP were associated with ECG measures indicative of subclinical myocardial dysfunction. These results may support future research investigating the significance of myocardial ischemia and volume overload in the pathogenesis of dysfunctional myocardial conduction in CKD.
在慢性肾脏病（CKD）患者中，循环心脏生物标志物可溶性 ST2（SST2）、半乳糖凝集素-3、生长分化因子-15（GDF-15）、N 末端 pro-B 型利钠肽前体（NT-proBNP）和高敏肌钙蛋白 T（hsTnT）可能反映了病理生理过程，并与临床心血管疾病相关。这些生物标志物是否与心电图表现有关尚不清楚。本研究旨在检验血清心脏生物标志物与 CKD 患者心电图（ECG）改变的关系，这些改变可能提示亚临床心肌疾病。
我们对无房颤、房室传导阻滞、束支传导阻滞或在基线就诊时安装起搏器的慢性肾功能不全队列（CRIC）3048 名参与者进行了横断面分析。我们使用逻辑回归检验了这五种心脏生物标志物中的每一种与基线 ECG 发现的关系：PR 间期>200ms、QRS 间期>100ms 和 QTc 间期延长。模型调整了人口统计学变量、肾功能测量、已确诊的心血管疾病和心血管危险因素。
在调整后的模型中，hsTnT 水平与 PR 间期延长相关（比值比 [OR] 1.23[95%置信区间（CI）1.08-1.40]）、QRS 间隔（OR 1.28[95%CI 1.16-1.42]）和 QTc 间隔（OR 1.94[95%CI 1.50-2.51]）。NT-proBNP 水平与 QRS 间隔延长相关（OR 1.11[95%CI 1.06-1.16]）和 QTc 间隔延长相关（OR 1.82[95%CI 1.58-2.10]）。SST2、半乳糖凝集素-3 和 GDF-15 与任何 ECG 参数均无显著相关性。
hsTnT 和 NT-proBNP 与提示亚临床心肌功能障碍的 ECG 指标相关。这些结果可能支持未来研究调查心肌缺血和容量超负荷在 CKD 致功能性心肌传导障碍发病机制中的意义。
