Nephrology and Dialysis Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy.
Department of Medical and Surgical Sciences-Renal Unit, Magna Graecia University of Catanzaro, Campus Salvatore Venuta, Viale Europa, 88100, Catanzaro, Italy.
Int Urol Nephrol. 2022 Oct;54(10):2581-2589. doi: 10.1007/s11255-022-03161-0. Epub 2022 Mar 10.
Left ventricular hypertrophy (LVH) is remarkably prevalent among end-stage kidney disease (ESKD) on chronic dialysis and has a strong prognostic value for adverse outcomes. In experimental models, the endogenous cardiotonic steroid Marinobufagenin (MBG) promotes cardiac hypertrophy and accelerates uremic cardiomyopathy. In this study, we investigated the possible relationships between MBG, LV geometry and cardiac dysfunction in a clinical setting of ESKD.
Plasmatic MBG was measured in 46 prevalent ESKD patients (n = 30 HD, n = 16 PD) together with a thorough laboratory, clinical, bioimpedance and echocardiography assessment. Different patterns of LV geometry were defined by left ventricular mass index (LVMi) and ventricular morphology. Diastolic dysfunction was diagnosed by the ASE/EACVI criteria.
MBG levels were significantly higher in ESKD patients than in healthy controls (p = 0.001) and more elevated in PD than in HD (p = 0.02). At multivariate analyses, E/e' (β = 0.38; p = 0.009) and LVMi (β = 0.42; p = 0.02) remained the sole independent predictors of MBG. A statistically significant trend in MBG levels (p = 0.01) was noticed across different patterns of LV geometry, with the highest values found in eccentric LVH. MBG levels were higher in the presence of diastolic dysfunction (p = 0.01) and this substance displayed a remarkable diagnostic capacity in distinguish patients with normal LV geometry, LV hypertrophy and, particularly, eccentric LVH (AUC 0.888; p < 0.0001) and diastolic dysfunction (AUC 0.79; p = 0.001).
Deranged plasma MBG levels in ESKD patients on chronic dialysis reflect alterations in LV structure and function. MBG may, thus, candidate as a novel biomarker for improving cardiac assessment in this high-risk population.
左心室肥厚（LVH）在慢性透析的终末期肾病（ESKD）患者中非常普遍，对不良预后具有很强的预测价值。在实验模型中，内源性强心甾体 Marinobufagenin（MBG）可促进心肌肥大并加速尿毒症性心肌病。在本研究中，我们在 ESKD 的临床环境中研究了 MBG、LV 几何形状和心脏功能障碍之间的可能关系。
在 46 名接受透析的 ESKD 患者（n=30 名血液透析患者，n=16 名腹膜透析患者）中测量了血浆 MBG，并进行了全面的实验室、临床、生物阻抗和超声心动图评估。根据左心室质量指数（LVMi）和心室形态定义不同的 LV 几何形状。舒张功能障碍根据 ASE/EACVI 标准进行诊断。
ESKD 患者的 MBG 水平明显高于健康对照组（p=0.001），腹膜透析患者高于血液透析患者（p=0.02）。在多变量分析中，E/e'（β=0.38；p=0.009）和 LVMi（β=0.42；p=0.02）仍然是 MBG 的唯一独立预测因子。MBG 水平在不同的 LV 几何形状模式中呈现出统计学上的显著趋势（p=0.01），其中偏心性 LVH 的值最高。在存在舒张功能障碍的情况下，MBG 水平更高（p=0.01），并且这种物质在区分具有正常 LV 几何形状、LV 肥大、特别是偏心性 LVH 和舒张功能障碍的患者方面具有出色的诊断能力（AUC 0.888；p<0.0001）和舒张功能障碍（AUC 0.79；p=0.001）。
慢性透析的 ESKD 患者中失调的血浆 MBG 水平反映了 LV 结构和功能的改变。因此，MBG 可能成为该高危人群心脏评估的一种新型生物标志物。
