Medical Sciences Postgraduate Program, Universidade de Fortaleza - UNIFOR, Fortaleza, Ceará, Brazil.
Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, Ceará, Brazil.
J Clin Hypertens (Greenwich). 2022 Apr;24(4):502-512. doi: 10.1111/jch.14465. Epub 2022 Mar 16.
Cardiac remodeling is the initial process in heart failure development. The aim of this study is to evaluate the association between endothelium-related biomarkers and cardiac remodeling in hemodialysis (HD) patients and how the presence of high blood pressure and diabetes mellitus modulates these associations. This was a cross-sectional study with adult HD and normal left ventricular (LV) ejection fraction-LVEF-patients. The authors correlated several endothelium-related biomarkers with echocardiographic indices-LV mass index (LVMi), LVEF, global longitudinal strain, mitral E/e', and aortic root diameter. Seventy-one patients were included, with 37 women (52.1%) and mean age of 54.3 ± 16.8 years. Angiopoietin-2 (AGPT2) was inversely correlated with global longitudinal strain (r = -.374, p = .001) and directly with E/e' (r = .265, p = .025). After adjustment, only AGPT2 was significantly associated with global longitudinal strain. blood pressure and diabetes mellitus were independent moderators for the AGPT2 and global longitudinal strain association. The conditional association was significant only when the mean pre-HD blood pressure was above 97.5 mmHg or in diabetes mellitus patients. Finally, there was an interaction between diabetes mellitus and blood pressure when moderating the conditional effect of AGPT2 on global longitudinal strain. While in non-diabetic patients, the association between AGPT2 with global longitudinal strain was significant only with pre-HD blood pressure levels as high as 110 mmHg, in diabetic patients, this association was significant with pre-HD blood pressure as low as 90 mmHg. Higher levels of AGPT2 were associated with worse cardiac function as determined by lower global longitudinal strain values. This association was moderated by blood pressure and diabetes mellitus, suggesting that the effects of AGPT2 on cardiac remodeling is dependent of such circumstances.
心脏重构是心力衰竭发展的初始过程。本研究旨在评估血液透析（HD）患者中内皮相关生物标志物与心脏重构之间的关系，以及高血压和糖尿病的存在如何调节这些关系。这是一项横断面研究，纳入了成年 HD 且左心室射血分数（LVEF）正常的患者。作者将几种内皮相关生物标志物与超声心动图指标（LV 质量指数[LVMi]、LVEF、整体纵向应变、二尖瓣 E/e'和主动脉根部直径）相关联。共纳入 71 例患者，其中女性 37 例（52.1%），平均年龄 54.3±16.8 岁。血管生成素-2（AGPT2）与整体纵向应变呈负相关（r=-0.374，p=0.001），与 E/e'呈正相关（r=0.265，p=0.025）。调整后，仅 AGPT2 与整体纵向应变显著相关。血压和糖尿病是 AGPT2 与整体纵向应变关联的独立调节因素。只有当平均预 HD 血压高于 97.5mmHg 或在糖尿病患者中时，条件关联才具有统计学意义。最后，当调节 AGPT2 对整体纵向应变的条件效应时，糖尿病和血压之间存在交互作用。在非糖尿病患者中，仅当预 HD 血压高达 110mmHg 时，AGPT2 与整体纵向应变之间的关联才具有统计学意义，而在糖尿病患者中，当预 HD 血压低至 90mmHg 时，这种关联就具有统计学意义。AGPT2 水平升高与整体纵向应变值降低相关，表明心脏功能更差。这种关联受血压和糖尿病的调节，提示 AGPT2 对心脏重构的影响取决于这些情况。
