Department of Medical Ultrasonics, First Affiliated Hospital with Jinzhou Medical University (Liaoning Province Hospital), No. 2, Section 5, Renmin Street, Guta District, Jinzhou, China.
Department of Nephrology, First Affiliated Hospital with Jinzhou Medical University, Jinzhou, China.
Int J Cardiovasc Imaging. 2024 Apr;40(4):873-885. doi: 10.1007/s10554-024-03056-4. Epub 2024 Jan 19.
Cardiovascular disease (CVD) is the leading cause of end-stage mortality in chronic kidney disease (CKD) patients. However, CVD and CKD are inextricably linked, as microalbuminuria is an independent risk factor for CVD. Herein, we investigated changes in cardiac function and its risk factors in CKD patients who had different urine albumin-to-creatinine ratios (UACRs) and estimated glomerular filtration rates (eGFRs). We prospectively enrolled 182 CKD patients, classified into three groups based on UACRs and eGFRs. Fifty healthy volunteers were included as controls. Changes in clinical and echocardiographic parameters were assessed in each group, and factors independently associated with strain parameters were further analyzed. Compared with those in the control group, the albuminuria but unimpaired renal function (ALB-CKD G1-2), albuminuria and impaired renal function (ALB-CKD G3), and normoalbuminuric CKD (NACKD) groups had decreased left ventricular (LV), right ventricular (RV), and left atrial (LA) strains, the LA contractile strain being the only statistically comparable parameter. Stepwise multiple linear regression analysis revealed varying factors independently correlating with the LV global longitudinal strain. The LA reservoir and conduit strains independently correlated with LV diastolic function in stage 3 CKD associated with comorbid albuminuria or normoalbuminuria. LV function was a partial determinant of LA and RV function in the ALB-CKD G3 group, whereas ventricular and atrial function were independent of each other in the ALB-CKD G1-2 and NACKD groups. Clinical intervention should focus on specific factors affecting cardiac function in patients to reduce the risk of CVD-related death.
心血管疾病(CVD)是慢性肾脏病(CKD)患者终末期死亡的主要原因。然而,CVD 和 CKD 是密切相关的,因为微量白蛋白尿是 CVD 的独立危险因素。在此,我们研究了不同尿白蛋白/肌酐比值(UACR)和估计肾小球滤过率(eGFR)的 CKD 患者心脏功能及其危险因素的变化。我们前瞻性纳入了 182 例 CKD 患者,根据 UACR 和 eGFR 将其分为三组。50 名健康志愿者作为对照组。评估每组的临床和超声心动图参数变化,并进一步分析与应变参数独立相关的因素。与对照组相比,白蛋白尿但肾功能正常(ALB-CKD G1-2)、白蛋白尿和肾功能不全(ALB-CKD G3)以及正常白蛋白尿 CKD(NACKD)组的左心室(LV)、右心室(RV)和左心房(LA)应变降低,LA 收缩应变是唯一具有统计学可比性的参数。逐步多元线性回归分析显示,不同的因素与 LV 整体纵向应变独立相关。在伴有合并白蛋白尿或正常白蛋白尿的 3 期 CKD 中,LA 储备和管道应变与 LV 舒张功能独立相关。LV 功能是 ALB-CKD G3 组中 LA 和 RV 功能的部分决定因素,而在 ALB-CKD G1-2 和 NACKD 组中,心室和心房功能相互独立。临床干预应侧重于影响患者心脏功能的特定因素,以降低 CVD 相关死亡的风险。