Zhu Shuangshuang, Zhang Yanting, Qiao Weihua, Wang Yixuan, Xie Yuji, Zhang Xin, Wu Chun, Wang Guohua, Li Yuman, Dong Nianguo, Xie Mingxing, Zhang Li
Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China.
Front Cardiovasc Med. 2022 Aug 9;9:931517. doi: 10.3389/fcvm.2022.931517. eCollection 2022.
Acute kidney injury (AKI) commonly occurs after heart transplantation (HTx), but its association with preoperative right ventricular (RV) function remains unknown. Consequently, we aimed to determine the predictive value of preoperative RV function for moderate to severe AKI after HTx.
From 1 January 2016 to 31 December 2019, all the consecutive HTx recipients in our center were enrolled and analyzed for the occurrence of postoperative AKI staged by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Conventional RV function parameters, including RV fractional area change (RVFAC) and tricuspid annular plane systolic excursion (TAPSE), were obtained. The primary endpoint was moderate to severe AKI (the KDIGO stage 2 or 3). The secondary endpoints included the impact of AKI on intensive care unit (ICU) mortality, in-hospital mortality, and 1-year mortality.
A total of 273 HTx recipients were included in the study. Postoperative AKI occurred in 209 (77%) patients, including 122 (45%) patients in stage 1 AKI, 49 (18%) patients in stage 2 AKI, and 38 (14%) patients in stage 3 AKI. Patients with higher AKI stage had lower baseline estimated glomerular filtration rate (eGFR), more frequent diabetes, higher right atrial pressure (RAP), longer cardiopulmonary bypass (CPB) duration, more perioperative red blood cell (RBC) transfusions, and worse preoperative RV function. A multivariate logistic regression model incorporating previous diabetes mellitus [odds ratio (OR): 2.21; 95% CI: 1.06-4.61; = 0.035], baseline eGFR (OR: 0.99; 95% CI: 0.97-0.10; = 0.037), RAP (OR: 1.05; 95% CI: 1.00-1.10; = 0.041), perioperative RBC (OR: 1.18; 95% CI: 1.08-1.28; < 0.001), and TAPSE (OR: 0.84; 95% CI: 0.79-0.91; < 0.001) was established to diagnose moderate to severe AKI more accurately [the area under the curve (AUC) = 79.8%; Akaike information criterion: 274].
Preoperative RV function parameters provide additional predicting value over clinical and hemodynamic parameters, which are imperative for risk stratification in patients with HTx at higher risk of AKI.
急性肾损伤（AKI）常见于心脏移植（HTx）术后，但其与术前右心室（RV）功能的关系尚不清楚。因此，我们旨在确定术前RV功能对HTx术后中度至重度AKI的预测价值。
2016年1月1日至2019年12月31日，纳入我们中心所有连续的HTx受者，并根据改善全球肾脏病预后组织（KDIGO）标准分析术后AKI的发生情况。获取常规RV功能参数，包括右心室面积变化分数（RVFAC）和三尖瓣环平面收缩期位移（TAPSE）。主要终点是中度至重度AKI（KDIGO 2期或3期）。次要终点包括AKI对重症监护病房（ICU）死亡率、住院死亡率和1年死亡率的影响。
本研究共纳入273例HTx受者。209例（77%）患者发生术后AKI，其中122例（45%）为1期AKI，49例（18%）为2期AKI，38例（14%）为3期AKI。AKI分期较高的患者基线估计肾小球滤过率（eGFR）较低、糖尿病更常见、右心房压力（RAP）较高、体外循环（CPB）时间较长、围手术期红细胞（RBC）输注较多，且术前RV功能较差。建立了一个多因素逻辑回归模型，纳入既往糖尿病[比值比（OR）：2.21；95%置信区间（CI）：1.06 - 4.61；P = 0.035]、基线eGFR（OR：0.99；95% CI：0.97 - 1.01；P = 0.037）、RAP（OR：1.05；95% CI：1.00 - 1.10；P = 0.041）、围手术期RBC（OR：1.18；95% CI：1.08 - 1.28；P < 0.001）和TAPSE（OR：0.84；95% CI：0.79 - 0.91；P < 0.001），以更准确地诊断中度至重度AKI[曲线下面积（AUC） = 79.8%；赤池信息准则：274]。
术前RV功能参数比临床和血流动力学参数具有额外的预测价值，这对于AKI风险较高的HTx患者进行风险分层至关重要。
