依特卡塞特德与阿法骨化醇对血液透析患者左心室功能及心脏磁共振特征追踪的影响：一项随机对照试验的事后分析。
Effect of etelcalcetide versus alfacalcidol on left ventricular function and feature-tracking cardiac magnetic resonance imaging in hemodialysis-a post-hoc analysis of a randomized, controlled trial.
机构信息
Department of Nephrology, Medical University of Vienna, Vienna, Austria.
Department of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
出版信息
J Cardiovasc Magn Reson. 2023 Nov 6;25(1):62. doi: 10.1186/s12968-023-00975-4.
BACKGROUND
Calcimimetic therapy with etelcalcetide (ETEL) has been shown to attenuate the advancement of left ventricular (LV) hypertrophy in hemodialysis patients measured by cardiac magnetic resonance (CMR). The aim of the study was to evaluate whether this effect is accompanied by alterations in LV function and myocardial composition.
METHODS
This was a post-hoc analysis of a randomized-controlled trial of ETEL versus Alfacalcidol (ALFA) in 62 hemodialysis patients. LV function was assessed using LV ejection fraction (LVEF) and LV global longitudinal strain (GLS) on feature-tracking (FT) CMR. Myocardial tissue characteristics were analyzed using parametric T1 and T2 mapping.
RESULTS
Of the total study cohort (n = 62), 48 subjects completed both CMR scans with sufficient quality for FT analysis. In the one-year follow-up, LV GLS deteriorated in the ALFA group, whereas the ETEL group remained stable (LV GLS change: + 2.6 ± 4.6 versus + 0.3 ± 3.8; p = 0.045 when adjusting for randomization factors and baseline LV GLS). We did not observe a difference in the change of LVEF between the two groups (p = 0.513). The impact of ETEL treatment on LV GLS over time remained significant after additional adjustment for the change in LV mass during the study period. ETEL treatment did not significantly affect other CMR parameters. There were no changes in myocardial composition between treatment groups (T1 time change: + 15 ± 42 versus + 10 ± 50; p = 0.411; T2 time change: - 0.13 ± 2.45 versus - 0.70 ± 2.43; p = 0.652).
CONCLUSIONS
In patients undergoing hemodialysis, treatment with ETEL was protective against deterioration of LV longitudinal function, as evaluated through FT CMR, when compared to the control therapy of ALFA. This effect was not mediated by the change in LV mass. Trial registration URL: https://clinicaltrials.gov/ct2/show/NCT03182699 . Unique identifier: NCT03182699.
背景
依特卡肽（ETEL）的钙敏感受体激动剂治疗已被证明可通过心脏磁共振（CMR）来减轻血液透析患者左心室（LV）肥厚的进展。本研究的目的是评估这种作用是否伴有 LV 功能和心肌成分的改变。
方法
这是一项 ETEL 与阿尔法骨化醇（ALFA）在 62 名血液透析患者中进行的随机对照试验的事后分析。使用特征追踪（FT）CMR 评估 LV 射血分数（LVEF）和 LV 整体纵向应变（GLS）来评估 LV 功能。使用参数 T1 和 T2 映射分析心肌组织特征。
结果
在总研究队列（n=62）中，48 名患者完成了两次 CMR 扫描，FT 分析的质量足够。在一年的随访中，ALFA 组的 LV GLS 恶化，而 ETEL 组保持稳定（LV GLS 变化：+2.6±4.6 与+0.3±3.8；调整随机因素和基线 LV GLS 后，p=0.045）。两组之间 LVEF 的变化没有差异（p=0.513）。在研究期间 LV 质量变化的基础上，ETEL 治疗对 LV GLS 的影响随时间变化仍有意义。ETEL 治疗对其他 CMR 参数没有显著影响。两组之间的心肌成分没有变化（T1 时间变化：+15±42 与+10±50；p=0.411；T2 时间变化：-0.13±2.45 与-0.70±2.43；p=0.652）。
结论
与 ALFA 对照治疗相比，在血液透析患者中，ETEL 治疗可防止 FT CMR 评估的 LV 纵向功能恶化。这种作用不是由 LV 质量的变化介导的。试验注册网址：https://clinicaltrials.gov/ct2/show/NCT03182699。独特标识符：NCT03182699。
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