Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark.
Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark, University of Copenhagen, Niels Andersens Vej 65, 2900, Hellerup, Copenhagen, Denmark.
Int J Cardiovasc Imaging. 2024 Jun;40(6):1221-1233. doi: 10.1007/s10554-024-03092-0. Epub 2024 Apr 30.
We investigated the associations between cardiac parameters and aetiologies of CKD in an exploratory study.
The study population consisted of 883 participants, 174 controls and 709 patients with aetiologies of CKD including diabetic nephropathy/renovascular KD in diabetes mellitus, hypertensive/renovascular nephropathy, tubulointerstitial nephritis, glomerulonephritis/vasculitis, polycystic KD (PKD), and CKD of unknown origin. Echocardiographic measures included left ventricular (LV) ejection fraction, global longitudinal, area, and radial strain, E/e' ratio, and LV mass index. These were compared between each aetiological group and controls in unadjusted and adjusted analysis.
In unadjusted analysis, patients with diabetic nephropathy/renovascular KD in diabetes mellitus, had impaired LV ejection fraction (Median [IQR]: 56% [49.9,60.69] vs. 60.8% [57.7,64.1]), global longitudinal (mean ± SD: 13.1 ± 3.5% vs. 15.5 ± 2.6%), area (24.1 ± 5.8% vs. 28.5 ± 4.2%), and radial strain (36.2 ± 11.2% vs. 44.1 ± 9.7%), and increased LV mass index (89.1 g/m [71.8,104.9] vs. 69,0 g/m [57.9,80.8]) and E/e' ratio (10.6 [8.5,12.6] vs. 7 [5.8,8.3], p < 0.001 for all) compared with controls. Associations were similar for CKD of unknown origin. Patients with hypertensive/renovascular nephropathy had impaired global longitudinal and area strain, and higher E/e' ratio. Patients with glomerulonephritis/vasculitis had higher LV mass index, while patients with PKD had better global longitudinal strain than controls. All findings remained significant in adjusted analysis, except for the impaired global longitudinal strain in hypertensive/renovascular nephropathy.
Glomerulonephritis/vasculitis, hypertensive/renovascular nephropathy, CKD of unknown origin, and diabetic nephropathy/renovascular KD in diabetes mellitus were increasingly associated with adverse cardiac findings, while PKD and tubulointerstitial nephritis were not. Aetiology might play a role regarding the cardiac manifestations of CKD.
在一项探索性研究中，我们调查了心脏参数与 CKD 病因之间的关联。
研究人群包括 883 名参与者，其中 174 名对照组和 709 名 CKD 病因患者，包括糖尿病患者中的糖尿病肾病/血管性肾病、高血压/血管性肾病、肾小管间质性肾炎、肾小球肾炎/血管炎、多囊肾病 (PKD) 和病因不明的 CKD。超声心动图测量包括左心室 (LV) 射血分数、整体纵向、面积和径向应变、E/e' 比值和 LV 质量指数。在未调整和调整分析中，将这些参数与每个病因组和对照组进行比较。
在未调整分析中，与对照组相比，糖尿病患者中的糖尿病肾病/血管性肾病患者的 LV 射血分数受损 (中位数 [IQR]：56% [49.9,60.69] 比 60.8% [57.7,64.1]）、整体纵向 (平均 ± 标准差：13.1 ± 3.5% 比 15.5 ± 2.6%）、面积 (24.1 ± 5.8% 比 28.5 ± 4.2%）和径向应变 (36.2 ± 11.2% 比 44.1 ± 9.7%）和 LV 质量指数增加（89.1 g/m [71.8,104.9] 比 69.0 g/m [57.9,80.8]）和 E/e' 比值增加（10.6 [8.5,12.6] 比 7 [5.8,8.3]，p < 0.001 均）。与病因不明的 CKD 相关的关联相似。高血压/血管性肾病患者的整体纵向和面积应变受损，E/e' 比值较高。肾小球肾炎/血管炎患者的 LV 质量指数较高，而 PKD 患者的整体纵向应变优于对照组。除高血压/血管性肾病患者的整体纵向应变受损外，所有发现均在调整分析中仍然显著。
肾小球肾炎/血管炎、高血压/血管性肾病、病因不明的 CKD 和糖尿病患者中的糖尿病肾病/血管性肾病与不良心脏发现呈正相关，而 PKD 和肾小管间质性肾炎则不然。病因可能在 CKD 的心脏表现中起作用。
