Lu Xiaozhao, Li Qiang, Deng Jingru, Kang Yu, Liang Guoxiao, Deng Linxiao, Guo Lei, Ruan Haodong, Peng Zibi, Li Jiaxi, Tan Ning, Chen Jiyan, Liu Jin, Wang Amanda Y, Liu Yong
Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China.
Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou 510080, China.
J Clin Med. 2023 Feb 24;12(5):1818. doi: 10.3390/jcm12051818.
The identification of asymptomatic structural and functional cardiac abnormalities can help us to recognize early and intervene in patients at pre-heart failure (HF). However, few studies have adequately evaluated the associations of renal function and left ventricular (LV) structure and function in patients at high risk of cardiovascular diseases (CVD).
Patients undergoing coronary angiography and/or percutaneous coronary interventions were enrolled from the Cardiorenal ImprovemeNt II (CIN-II) cohort study, and their echocardiography and renal function were assessed at admission. Patients were divided into five groups according to their estimated glomerular filtration rate (eGFR). Our outcomes were LV hypertrophy and LV systolic and diastolic dysfunction. Multivariable logistic regression analyses were conducted to investigate the associations of eGFR with LV hypertrophy and LV systolic and diastolic dysfunction.
A total of 5610 patients (mean age: 61.6 ± 10.6 years; 27.3% female) were included in the final analysis. The prevalence of LV hypertrophy assessed by echocardiography was 29.0%, 34.8%, 51.9%, 66.7%, and 74.3% for the eGFR categories >90, 61-90, 31-60, 16-30, and ≤15 mL/min per 1.73 m or for patients needing dialysis, respectively. Multivariate logistic regression analysis showed that subjects with eGFR levels of ≤15 mL/min per 1.73 m2 or needing dialysis (OR: 4.66, 95% CI: 2.96-7.54), as well as those with eGFR levels of 16-30 (OR: 3.87, 95% CI: 2.43-6.24), 31-60 (OR: 2.00, 95% CI: 1.64-2.45), and 61-90 (OR: 1.23, 95% CI: 1.07-1.42), were significantly associated with LV hypertrophy. This reduction in renal function was also significantly associated with LV systolic and diastolic dysfunction (all P for trend <0.001). In addition, a per one unit decrease in eGFR was associated with a 2% heightened combined risk of LV hypertrophy and systolic and diastolic dysfunction.
Among patients at high risk of CVD, poor renal function was strongly associated with cardiac structural and functional abnormalities. In addition, the presence or absence of CAD did not change the associations. The results may have implications for the pathophysiology behind cardiorenal syndrome.
识别无症状的心脏结构和功能异常有助于我们在心力衰竭（HF）前期患者中早期识别并进行干预。然而，很少有研究充分评估心血管疾病（CVD）高危患者的肾功能与左心室（LV）结构和功能之间的关联。
从心脏肾改善II（CIN-II）队列研究中纳入接受冠状动脉造影和/或经皮冠状动脉介入治疗的患者，并在入院时评估其超声心动图和肾功能。根据估算的肾小球滤过率（eGFR）将患者分为五组。我们的观察指标为左心室肥厚以及左心室收缩和舒张功能障碍。进行多变量逻辑回归分析以研究eGFR与左心室肥厚以及左心室收缩和舒张功能障碍之间的关联。
最终分析纳入了5610例患者（平均年龄：61.6±10.6岁；27.3%为女性）。对于eGFR类别>90、61 - 90、31 - 60、16 - 30以及≤15 mL/min per 1.73 m²或需要透析的患者，经超声心动图评估的左心室肥厚患病率分别为29.0%、34.8%、51.9%、66.7%和74.3%。多变量逻辑回归分析显示，eGFR水平≤15 mL/min per 1.73 m²或需要透析的受试者（比值比：4.66，95%置信区间：2.96 - 7.54），以及eGFR水平为16 - 30（比值比：3.87，95%置信区间：2.43 - 6.24）、31 - 60（比值比：2.00，95%置信区间：1.64 - 2.45）和61 - 90（比值比：1.23，95%置信区间：1.07 - 1.42）的受试者与左心室肥厚显著相关。肾功能的这种下降也与左心室收缩和舒张功能障碍显著相关（所有趋势P值<0.001）。此外，eGFR每降低一个单位，左心室肥厚以及收缩和舒张功能障碍的综合风险升高2%。
在CVD高危患者中，肾功能不佳与心脏结构和功能异常密切相关。此外，是否存在冠心病并不改变这种关联。这些结果可能对心肾综合征背后的病理生理学有启示意义。
