Miyajima Yoshiyasu, Toyama Tadashi, Mori Mika, Nakade Yusuke, Sato Koichi, Yamamura Yuta, Ogura Hisayuki, Yoneda-Nakagawa Shiori, Oshima Megumi, Miyagawa Taro, Usui Soichiro, Oe Hiroyasu, Kitajima Shinji, Hara Akinori, Iwata Yasunori, Sakai Norihiko, Shimizu Miho, Sakai Yoshio, Furuichi Kengo, Wada Takashi
Department of Nephrology and Laboratory Medicine, Kanazawa University, Kanazawa, Japan.
Department of Clinical Laboratory, Kanazawa University Hospital, Kanazawa, Japan.
J Nephrol. 2021 Jun;34(3):773-780. doi: 10.1007/s40620-020-00940-9. Epub 2021 Jan 5.
Preclinical left ventricular diastolic dysfunction (LVDD) is a high-risk state for heart failure. Kidney dysfunction is a known risk factor for heart failure, but its association with asymptomatic LVDD is not well-known.
A hospital-based retrospective cohort study was conducted on patients who underwent echocardiogram between 2006 and 2016 to assess the association between baseline kidney function and LVDD on echocardiogram. E/e' ratio was defined as the ratio of peak velocity of early diastolic left ventricular inflow (E) to mitral annular velocity (e'). The primary outcome was time to development of LVDD, which was defined as E/e' ratio > 14. The changes in the E/e' ratio and other echocardiographic parameters were assessed using a mixed effects model.
Among 1167 patients, the mean age was 61 years, and the mean baseline E/e' ratio and ejection fraction were 9.6 and 69%, respectively. During a median follow-up of 3.2 years, 231 (19.8%) people developed LVDD. According to eGFR (mL/min/1.73 m), the risk for LVDD based on hazard ratio [95% confidence interval (95% CI)] was 1.20 (0.82, 1.75) for 60 to < 90, 1.42 (0.87, 2.31) for 45 to < 60, and 2.57 (1.61, 4.09) for < 45 (P trend < 0.001). The adjusted risks (95% CI) for annual change in E/e' ratio was 0.09 (0.03, 0.14) overall and 0.28 (0.11, 0.45) in the lowest eGFR group; the trend in changes in annual E/e' ratio by baseline eGFR was significant (P trend = 0.01).
Relatively low kidney function was related with the risks for LVDD. Long-term cohort studies are warranted to confirm the association between LVDD and symptomatic heart failure in patients with kidney dysfunction.
临床前左心室舒张功能障碍（LVDD）是心力衰竭的高危状态。肾功能不全是心力衰竭的已知危险因素，但其与无症状LVDD的关联尚不明确。
对2006年至2016年间接受超声心动图检查的患者进行了一项基于医院的回顾性队列研究，以评估基线肾功能与超声心动图上LVDD之间的关联。E/e'比值定义为舒张早期左心室流入峰值速度（E）与二尖瓣环速度（e'）之比。主要结局是发生LVDD的时间，定义为E/e'比值>14。使用混合效应模型评估E/e'比值和其他超声心动图参数的变化。
在1167例患者中，平均年龄为61岁，平均基线E/e'比值和射血分数分别为9.6和69%。在中位随访3.2年期间，231例（19.8%）患者发生了LVDD。根据估算肾小球滤过率（eGFR，mL/min/1.73 m²），基于风险比[95%置信区间（95%CI）]，LVDD的风险在eGFR为60至<90时为1.20（0.82，1.75），45至<60时为1.42（0.87，2.31），<45时为2.57（1.61，4.09）（P趋势<0.001）。E/e'比值年度变化的校正风险（95%CI）总体为0.09（0.03，0.14），在最低eGFR组为0.28（0.11，0.45）；基线eGFR导致的E/e'比值年度变化趋势具有显著性（P趋势=0.01）。
相对较低的肾功能与LVDD风险相关。需要进行长期队列研究以证实肾功能不全患者中LVDD与症状性心力衰竭之间的关联。
