Anastasiou Vasileios, Peteinidou Emmanouela, Tountas Christos, Daios Stylianos, Moysidis Dimitrios V, Fardoulis Emmanouil, Gogos Christos, Theodorakopoulou Marieta, Iatridi Fotini, Sarafidis Pantelis, Giannakoulas George, Karamitsos Theodoros, Delgado Victoria, Ziakas Antonios, Kamperidis Vasileios
1st Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, 546 36 Thessaloniki, Greece.
Cardiology Department, Sismanoglio Hospital, 151 26 Athens, Greece.
Diagnostics (Basel). 2024 Jul 21;14(14):1576. doi: 10.3390/diagnostics14141576.
In acute heart failure (HF), low cardiac output and venous congestion are pathophysiological mechanisms that contribute to renal function impairment. This study investigated the association between advanced echocardiographic measures of right ventricular and atrial function and renal impairment in patients with acute HF.
A total of 377 patients hospitalized for acute HF were prospectively evaluated. Estimated glomerular filtration rate (eGFR) on admission was measured using the 2021 Chronic Kidney Disease Epidemiology Collaboration creatinine equation. Advanced echocardiographic assessment was performed on admission. Patients with eGFR < 45 mL/min/1.73 m were more likely to have chronic heart failure, chronic atrial fibrillation, and type 2 diabetes mellitus compared to patients with eGFR ≥ 45 mL/min/1.73 m. Patients with lower eGFR had lower cardiac output, higher mean E/e' ratio, larger right ventricular (RV) size, worse RV free wall longitudinal strain, more impaired right atrial (RA) reservoir strain, and more frequent severe tricuspid regurgitation. RV free wall longitudinal strain and RA reservoir strain were the only independent echocardiographic associates of low eGFR, whereas cardiac output was not.
Impaired RV and RA longitudinal strain were independently associated with eGFR < 45 mL/min/1.73 m in acute HF, while reduced cardiac output was not. This suggests that RV and RA dysfunction underlying venous congestion and increased renal afterload are more important pathophysiological determinants of renal impairment in acute HF than reduced cardiac output.
在急性心力衰竭（HF）中，低心输出量和静脉充血是导致肾功能损害的病理生理机制。本研究调查了急性HF患者右心室和心房功能的高级超声心动图测量指标与肾功能损害之间的关联。
对377例因急性HF住院的患者进行了前瞻性评估。入院时使用2021年慢性肾脏病流行病学协作组肌酐方程测量估算肾小球滤过率（eGFR）。入院时进行了高级超声心动图评估。与eGFR≥45 mL/min/1.73 m²的患者相比，eGFR<45 mL/min/1.73 m²的患者更有可能患有慢性心力衰竭、慢性心房颤动和2型糖尿病。eGFR较低的患者心输出量较低、平均E/e'比值较高、右心室（RV）尺寸较大、RV游离壁纵向应变较差、右心房（RA）储备应变受损更严重，且严重三尖瓣反流更频繁。RV游离壁纵向应变和RA储备应变是eGFR降低的唯一独立超声心动图相关因素，而心输出量不是。
在急性HF中，RV和RA纵向应变受损与eGFR<45 mL/min/1.73 m²独立相关，而心输出量降低则不然。这表明，静脉充血和肾后负荷增加背后的RV和RA功能障碍是急性HF中肾功能损害比心输出量降低更重要的病理生理决定因素。
