Division of Nephrology, David Geffen School of Medicine at UCLA, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Room 6030, Los Angeles, CA, 90073, USA.
Stritch School of Medicine, Loyola University Chicago, IL, Maywood, USA.
Pediatr Nephrol. 2023 Jul;38(7):2179-2187. doi: 10.1007/s00467-022-05812-x. Epub 2022 Dec 12.
FGF23 mediates cardiac fibrosis through the activation of pro-fibrotic factors in in vitro models and is markedly elevated in kidney disease. Left atrial global longitudinal strain (LA GLS) derived by echocardiographic speckle-tracking measures longitudinal shortening of the LA walls, quantifies atrial performance and may enable detection of early LA remodeling in the setting of normal ventricular function. We hypothesized that LA GLS is abnormal in children on hemodialysis (HD) compared to healthy controls of comparable age/sex distribution and that, among HD patients, greater FGF23 levels are associated with abnormal LA GLS.
Clinical and echocardiographic data from 29 children receiving HD and 13 healthy controls were collected in a cross-sectional single-center study. Plasma FGF23 concentrations were measured using ELISA. The primary outcome was LA GLS measured using 2D speckle-tracking strain analysis. Linear regression analysis was used to investigate predictors of LA GLS in HD.
Median dialysis vintage was 1.5 (IQR 0.5-4.3) years. Median intact FGF23 levels were substantially higher in the HD vs. control group (1206 [215, 4707] vs. 51 [43, 66.5] pg/ml; P = 0.0001), and LA GLS was 39.9% SD 11.6 vs. 32.8% SD 5.7 (P = 0.04). Among HD patients, higher FGF23 was associated with lower LA GLS (β per unit Ln-FGF23: - 2.7; 95% CI slope - 5.4, - 0.1; P = 0.04 after adjustment for age, body size, and HD vintage. FGF23 was not associated with LA phasic reservoir, conduit, or contractile strain.
In children on HD and preserved left ventricular ejection fraction, greater FGF23 is associated with lower LA GLS (indicative of impaired atrial performance). A higher resolution version of the Graphical abstract is available as Supplementary information.
在体外模型中，FGF23 通过激活促纤维化因子介导心脏纤维化，并且在肾脏疾病中显著升高。超声心动图斑点追踪测量的左心房整体纵向应变（LA GLS）可测量 LA 壁的纵向缩短，量化心房功能，并且可能在正常心室功能的情况下检测到早期 LA 重构。我们假设与年龄/性别分布相匹配的健康对照组相比，血液透析（HD）患儿的 LA GLS 异常，并且在 HD 患者中，较高的 FGF23 水平与异常的 LA GLS 相关。
在一项横断面单中心研究中，收集了 29 名接受 HD 治疗的儿童和 13 名健康对照者的临床和超声心动图数据。使用 ELISA 测量血浆 FGF23 浓度。主要结局是使用二维斑点追踪应变分析测量的 LA GLS。使用线性回归分析来研究 HD 患者中 LA GLS 的预测因素。
中位透析龄为 1.5（IQR 0.5-4.3）年。HD 组与对照组相比，完整 FGF23 水平显著升高（1206[215，4707]vs.51[43，66.5]pg/ml；P = 0.0001），LA GLS 为 39.9% SD 11.6 vs.32.8% SD 5.7（P = 0.04）。在 HD 患者中，较高的 FGF23 与较低的 LA GLS 相关（每单位 Ln-FGF23 的 β 值：-2.7；95%CI 斜率-5.4，-0.1；P = 0.04，经年龄、体型和 HD 龄调整后）。FGF23 与 LA 时相储备、导管或收缩应变均无关。
在左心室射血分数保留的 HD 患儿中，较高的 FGF23 与较低的 LA GLS 相关（提示心房功能受损）。可提供图形抽象的更高分辨率版本作为补充信息。
