左心室能量损耗对射血分数保留的慢性肾脏病患者不良事件预测的增量价值。
The incremental value of left ventricular energy loss in predicting adverse events in chronic kidney disease patients with preserved ejection fraction.
机构信息
Department of Cardiac Ultrasound, Second Hospital of Hebei Medical University, No.215, Hepingxi Road, Shijiazhuang 050000, Hebei, China.
Department of Cardiac Ultrasound, Second Hospital of Hebei Medical University, No.215, Hepingxi Road, Shijiazhuang 050000, Hebei, China.
出版信息
Int J Cardiol. 2024 Nov 15;415:132360. doi: 10.1016/j.ijcard.2024.132360. Epub 2024 Aug 5.
BACKGROUND
Vector flow mapping (VFM) is a new echocardiographic technology that can effectively evaluate systolic and diastolic hemodynamic function. However, little is known about the prognostic value of VFM-related parameters. In this paper we aimed to investigate whether left ventricular energy loss (EL) parameters as assessed by VFM enhance prediction of adverse events in patients with chronic kidney disease with preserved ejection fraction.
METHODS
One hundred thirty-nine prospectively recruited patients (66% male, 58% on dialysis) with CKD stage 3-5 with normal left ventricular ejection fraction (LVEF) made up the study cohort. Global longitudinal strain (GLS) was calculated using 2-dimensional speckle tracking, and the LV EL during one cardiac cycle for each period was measured using VFM technology. Participants were followed for 4.17 ± 1.58 years for the primary end point of overall mortality and major adverse cardiovascular events (MACE).
RESULTS
Forty-five (32%) patients had a primary endpoint event. The EL during each period especially during the ejection stage (Ej-EL) was significantly higher in patients with adverse events than in those without, meanwhile the LV GLS were lower. The Ej-EL (HR: 1.11; 95% CI: 1.06-1.15) and LV GLS (HR: 0.87; 95% CI: 0.81-0.94) (all P < .001) were independent predictors for the primary end point. Increased Ej-EL (≥6.13, 10 J/m s) and impaired GLS (<15.52, %) were associated with a higher risk of overall mortality death and MACE (log rank χ2 = 26.94, 7.19; P < .001, =0.007), and DeLong tests showed that Ej-EL (AUC = 0.823) has a slight advantage in predicting adverse events compared to GLS (AUC = 0.681). Furthermore, the addition of Ej-EL to a model with conventional parameters did more to improve the model's discrimination compared to GLS.
CONCLUSIONS
Increased Ej-EL as determined by VFM is associated with a higher risk of overall death and MACE in CKD patients with preserved EF.
背景
向量流映射（VFM）是一种新的超声心动图技术，可有效评估收缩期和舒张期血流动力学功能。然而，关于 VFM 相关参数的预后价值知之甚少。在本文中，我们旨在探讨 VFM 评估的左心室能量损失（EL）参数是否能增强对慢性肾脏病伴射血分数保留患者不良事件的预测。
方法
前瞻性纳入 139 名慢性肾脏病 3-5 期且左心室射血分数（LVEF）正常的患者（66%为男性，58%在透析）作为研究队列。使用二维斑点追踪法计算整体纵向应变（GLS），使用 VFM 技术测量每个心动周期的左心室 EL。参与者的主要终点是全因死亡率和主要不良心血管事件（MACE），随访时间为 4.17±1.58 年。
结果
45 例（32%）患者发生了主要终点事件。与无不良事件的患者相比，有不良事件的患者在每个心动周期的 EL 特别是射血期 EL（Ej-EL）更高，同时左心室 GLS 更低。Ej-EL（HR：1.11；95%CI：1.06-1.15）和 LV GLS（HR：0.87；95%CI：0.81-0.94）（均 P<.001）是主要终点的独立预测因素。升高的 Ej-EL（≥6.13，10 J/m·s）和受损的 GLS（<15.52，%）与全因死亡和 MACE 的风险增加相关（对数秩 χ2=26.94，7.19；P<.001，=0.007），DeLong 检验表明，与 GLS（AUC=0.681）相比，Ej-EL（AUC=0.823）在预测不良事件方面具有轻微优势。此外，与常规参数相比，将 Ej-EL 加入模型后，模型的区分度提高更多。
结论
由 VFM 确定的升高的 Ej-EL 与 CKD 患者射血分数保留时的全因死亡和 MACE 风险增加相关。
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