Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Gentofte Hospitalsvej 8, 2900, Hellerup, Denmark.
Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark.
Clin Res Cardiol. 2024 Nov;113(11):1576-1588. doi: 10.1007/s00392-024-02459-6. Epub 2024 May 15.
Myocardial work is a novel echocardiographic measure that offers detailed insights into cardiac mechanics. We sought to characterize cardiac function by myocardial work in patients with chronic kidney disease (CKD).
We prospectively enrolled 757 patients with non-dialysis-dependent CKD and 174 age- and sex-matched controls. Echocardiographic pressure-strain loop analysis was performed to acquire the global work index (GWI). Linear regressions were performed to investigate the association between estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (UACR) to GWI.
Patients with CKD had a mean age of 57 years, 61% were men, and median eGFR was 42 mL/min/1.73 m. Overall, no difference in GWI was observed between patients and controls (1879 vs. 1943 mmHg%, p = 0.06). However, a stepwise decline in GWI was observed for controls vs. patients with CKD without left ventricular hypertrophy vs. patients with CKD and left ventricular hypertrophy (GWI, 1943 vs. 1887 vs. 1789 mmHg%; p for trend = 0.030). In patients with CKD, eGFR was not associated with GWI by linear regression. However, diabetes modified this association (p for interaction = 0.007), such that per 10 mL/min/1.73 m decrease in eGFR, GWI decreased by 22 (9-35) mmHg% (p = 0.001) after multivariable adjustments in patients without diabetes, but with no association between eGFR and GWI in patients with diabetes. No association was observed between UACR and GWI.
Patients with CKD and left ventricular hypertrophy exhibited lower myocardial work compared to matched controls. Furthermore, decreasing eGFR was associated with decreasing myocardial work only in patients without diabetes. No association to UACR was observed.
心肌做功是一种新颖的超声心动图测量方法，可深入了解心脏力学。我们旨在通过心肌做功来描述慢性肾脏病（CKD）患者的心脏功能。
我们前瞻性纳入了 757 名非透析依赖型 CKD 患者和 174 名年龄和性别匹配的对照者。通过超声心动图压力-应变环分析获取整体做功指数（GWI）。进行线性回归以探讨估算肾小球滤过率（eGFR）和尿白蛋白/肌酐比值（UACR）与 GWI 的相关性。
CKD 患者的平均年龄为 57 岁，61%为男性，中位 eGFR 为 42 mL/min/1.73 m。总体而言，患者与对照组的 GWI 无差异（1879 与 1943 mmHg%，p=0.06）。然而，在无左心室肥厚的对照组与 CKD 患者、CKD 合并左心室肥厚患者中，GWI 呈逐渐下降趋势（GWI，1943 与 1887 与 1789 mmHg%；p 趋势=0.030）。在 CKD 患者中，线性回归未显示 eGFR 与 GWI 相关。然而，糖尿病改变了这种相关性（p 交互=0.007），即 eGFR 每下降 10 mL/min/1.73 m，无糖尿病的患者 GWI 降低 22（9-35）mmHg%（p=0.001），而糖尿病患者的 eGFR 与 GWI 之间无相关性。UACR 与 GWI 无相关性。
与匹配的对照组相比，CKD 合并左心室肥厚患者的心肌做功较低。此外，eGFR 下降仅与无糖尿病的患者的心肌做功下降相关，与 UACR 无关。
