Li Fengqin, Ding Miao, Wang Yanzhe, Chen Qijie, Wu Yue, Zeng Chuchu, Zhang Nan, Zhu Dingyu, Wang Xiaoxia
Department of Nephrology, Shanghai Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Blood Purif. 2024;53(3):200-209. doi: 10.1159/000535249. Epub 2023 Nov 21.
Left ventricular diastolic dysfunction (LVDD) frequently occurs in haemodialysis patients and is associated with adverse outcomes. Lung ultrasound (LUS) has been recently proposed for the quantification of extravascular lung water through assessment of B-lines. LUS findings and their relationship with LVDD in clinically euvolemic haemodialysis patients were investigated in this study.
Echocardiography and LUS examinations were performed on each patient. Multivariate linear regression and forward stepwise logistic regression were performed to determine the relationship between B-lines and LVDD. A receiver operating characteristic (ROC) curve with area under the curve (AUC) was calculated to determine the accuracy of B-lines for evaluating LVDD.
A total of 119 patients were enrolled. The number of B-lines was statistically related to echocardiographic parameters (LAVI, LVEDVI, E/A, and E/e') of diastolic function, while the relationship between B-lines and LVEF disappeared after adjusting for potential confounding factors. Additionally, compared with the mild B-line group (B-lines: <14), the moderate (B-lines: 14-30) and severe B-line groups (B-lines: >30) were associated with an increased risk of LVDD (OR 24.344, 95% CI 4.854-122.084, p < 0.001, and OR 94.552, 95% CI 9.617-929.022, p < 0.001, respectively). Furthermore, the AUC of the ROC curve for B-lines predicting LVDD was 0.845, and the cut-off of B-lines was 14.5 (sensitivity 64.91%, specificity 93.55%).
LUS B-lines were closely associated with left ventricular diastolic function in clinically euvolemic haemodialysis patients. Moreover, our findings suggested a B-line ≥14.5 as a reliable cut-off value for identifying patients with LVDD. LUS B-lines may be used as a novel indicator for evaluating LVDD.
左心室舒张功能障碍（LVDD）在血液透析患者中经常出现，且与不良预后相关。最近有人提出通过评估B线来利用肺部超声（LUS）定量血管外肺水。本研究调查了临床血容量正常的血液透析患者的LUS检查结果及其与LVDD的关系。
对每位患者进行超声心动图和LUS检查。进行多变量线性回归和向前逐步逻辑回归以确定B线与LVDD之间的关系。计算具有曲线下面积（AUC）的受试者工作特征（ROC）曲线，以确定B线评估LVDD的准确性。
共纳入119例患者。B线数量与舒张功能的超声心动图参数（LAVI、LVEDVI、E/A和E/e'）在统计学上相关，而在调整潜在混杂因素后，B线与LVEF之间的关系消失。此外，与轻度B线组（B线：<14）相比，中度（B线：14 - 30）和重度B线组（B线：>30）发生LVDD的风险增加（OR分别为24.344，95%CI 4.854 - 122.084，p < 0.001；以及OR 94.552，95%CI 9.617 - 929.022，p < 0.001）。此外，B线预测LVDD的ROC曲线AUC为0.845，B线的截断值为14.5（敏感性64.91%，特异性93.55%）。
在临床血容量正常的血液透析患者中，LUS B线与左心室舒张功能密切相关。此外，我们的研究结果表明B线≥14.5是识别LVDD患者的可靠截断值。LUS B线可作为评估LVDD的新指标。
