Department of Cardiology, Kaiser Permanente Santa Clara Medical Center, Santa Clara, CA, USA.
Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612-2304, USA.
Sci Rep. 2023 May 31;13(1):8863. doi: 10.1038/s41598-023-35440-w.
Adults with chronic kidney disease (CKD) are at increased risk for developing heart failure (HF). However, longitudinal cardiac remodeling in CKD has not been well-characterized and its association with HF outcomes remains unknown. We evaluated the association between change in echocardiographic parameters between baseline and year 4 with the subsequent risk of HF hospitalization and death using Cox proportional hazard models in a landmark analysis of a prospective multicenter CKD cohort. Among 2673 participants, mean ± SD age was 61 ± 11 years, with 45% women, and 56% non-white. A total of 472 hospitalizations for HF and 776 deaths occurred during a median (interquartile range) follow-up duration of 8.0 (6.3-9.1) years. Patients hospitalized for HF experienced larger preceding absolute increases in left ventricular (LV) volumes and decreases in LV ejection fraction. Adverse changes in LV ejection fraction, LV cavity volume, LV mass index, and LV geometry were independently associated with an increased risk of HF hospitalization and death. Among adults with CKD, deleterious cardiac remodeling occurs over a relatively short timeframe and adverse remodeling is associated with increased risk of HF-related morbidity and mortality.
患有慢性肾病（CKD）的成年人患心力衰竭（HF）的风险增加。然而，CKD 患者的纵向心脏重构尚未得到很好的描述，其与 HF 结局的关系尚不清楚。我们使用 Cox 比例风险模型，对前瞻性多中心 CKD 队列的标志性分析进行了评估，该模型评估了基线和第 4 年之间超声心动图参数变化与随后 HF 住院和死亡风险之间的关系。在 2673 名参与者中，平均年龄为 61±11 岁，女性占 45%，非白人占 56%。中位（四分位间距）随访时间为 8.0（6.3-9.1）年，共发生 472 例 HF 住院和 776 例死亡。HF 住院患者经历了更大的左心室（LV）容积绝对增加和 LV 射血分数下降。LV 射血分数、LV 腔容积、LV 质量指数和 LV 几何结构的不良变化与 HF 住院和死亡风险增加独立相关。在患有 CKD 的成年人中，有害的心脏重构发生在相对较短的时间内，不良的重构与 HF 相关发病率和死亡率增加相关。
