Chen Ke-Wei, Hsieh Wen-Tsong, Huang Chih-Yang, Huang Chih-Chia, Liang Hsin-Yueh, Wang Guei-Jane
Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan; Department of Cardiology, China Medical University Hospital, Taichung, Taiwan.
Department of Pharmacology, School of Medicine, China Medical University, Taichung, Taiwan.
J Diabetes Complications. 2021 May;35(5):107890. doi: 10.1016/j.jdiacomp.2021.107890. Epub 2021 Feb 16.
A non-invasive method for left ventricular pressure-strain analysis has recently been introduced to provide information on cardiac work and detect subtler changes in cardiac function. This study aims to verify and construct a novel index that could accurately and independently predict the prognosis of patients with end-stage kidney disease (ESRD) receiving regular hemodialysis.
Patients with end-stage kidney disease (ESRD) receiving maintenance hemodialysis (4-h sessions, 3 times weekly for 3 months or more) and who underwent echocardiography between 2009 and 2014 in China Medical University Hospital, Taichung, Taiwan, were enrolled. Conventional (left ventricular ejection fraction, LVEF) and strain echocardiography parameters (global longitudinal strain, GLS; cardiac work index, CWI) in 102 eligible patients were analyzed and compared. CWI was calculated from estimated LV pressure-myocardial strain loop area.
Results show that, while no significant differences were found between LVEF (0.57 ± 0.12 vs. 0.59 ± 0.09, P = 0.27) and GLS (-16.12 ± 6.57% vs. -18.44 ± 5.54%, P = 0.07), deceased patients had significantly lower CWI (1339 ± 683.05 mmHg% vs. 1883.38 ± 640.99 mmHg%, P = 0.0002) than surviving patients. The predictive values defined by area under the curve (AUC) of LVEF, GLS and CWI were 0.499, 0.619 and 0.724, respectively.
In conclusion, CWI is an accurately independent predictor of all-cause mortality in ESRD patients receiving regular hemodialysis and may superior to the current predictors such as LVEF and GLS.
最近引入了一种用于左心室压力-应变分析的非侵入性方法，以提供有关心脏做功的信息并检测心脏功能中更细微的变化。本研究旨在验证并构建一种能够准确且独立地预测接受定期血液透析的终末期肾病（ESRD）患者预后的新指标。
纳入2009年至2014年期间在台湾台中中国医药大学医院接受维持性血液透析（每次4小时，每周3次，持续3个月或更长时间）且接受超声心动图检查的终末期肾病（ESRD）患者。分析并比较了102例符合条件患者的常规（左心室射血分数，LVEF）和应变超声心动图参数（整体纵向应变，GLS；心脏做功指数，CWI）。CWI由估计的左心室压力-心肌应变环面积计算得出。
结果显示，虽然LVEF（0.57±0.12对0.59±0.09，P = 0.27）和GLS（-16.12±6.57%对-18.44±5.54%，P = 0.07）之间未发现显著差异，但死亡患者的CWI（1339±683.05 mmHg%对1883.38±640.99 mmHg%，P = 0.0002）明显低于存活患者。LVEF、GLS和CWI的曲线下面积（AUC）定义的预测值分别为0.499、0.619和0.724。
总之，CWI是接受定期血液透析的ESRD患者全因死亡率的准确独立预测指标，可能优于目前的预测指标如LVEF和GLS。
