Kula Alexander J, Xu Yunwen, Hill Garick D, Furth Susan L, Warady Bradley A, Ng Derek K, Seegmiller Jeese, Mitsnefes Mark
Division of Pediatric Nephrology, Ann and Robert H. Lurie Children's Hospital of Chicago, IL (A.J.K.).
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Y.X., D.K.N.).
Hypertension. 2024 Oct;81(10):2181-2188. doi: 10.1161/HYPERTENSIONAHA.124.23167. Epub 2024 Aug 28.
Left ventricular global longitudinal strain (LV GLS) on echocardiography is a sensitive yet clinically significant marker of myocardial dysfunction. Reduced LV GLS is prevalent in adults with chronic kidney disease and hypertension and is associated with adverse cardiovascular outcomes. It may be a biomarker of chronic kidney disease-associated myocardial dysfunction in children, but data are limited. Our objective was to describe LV GLS in the CKiD study (Chronic Kidney Disease in Children) and to examine the association between blood pressure (BP) and reduced LV GLS.
A single apical 4-chamber view was used to estimate LV GLS. Our main analyses examined the association of clinic BP with the absolute value of LV GLS and LV GLS dichotomized at 16. Sensitivity analyses using 24-hour ambulatory BP monitoring data were also performed. Generalized estimating equations were used to account for within-person correlation and to estimate robust SEs for 95% CIs. Covariates in adjusted models included: age, sex, race, estimated glomerular filtration rate, urine protein, hemoglobin, left ventricular hypertrophy, and the use of renin-angiotensin system inhibitors.
LV GLS was measured in 962 person-visits. A total of 77 assessments had an LV GLS <16. In adjusted models, both clinic systolic BP (odds ratio, 1.02 [95% CI, 1.01-1.03]) and diastolic BP (odds ratio, 1.02 [95% CI, 1.00-1.03]) percentiles were associated with LV GLS <16. Having awake or nighttime diastolic BP hypertension on ambulatory BP monitoring was significantly associated with a lower absolute value of LV GLS.
Office systolic and diastolic hypertension was associated with diminished LV GLS. Only diastolic hypertension detected on ambulatory BP monitoring was associated with lower LV GLS.
超声心动图测量的左心室整体纵向应变（LV GLS）是心肌功能障碍的一个敏感且具有临床意义的标志物。LV GLS降低在患有慢性肾脏病和高血压的成年人中很常见，并且与不良心血管结局相关。它可能是儿童慢性肾脏病相关心肌功能障碍的一个生物标志物，但数据有限。我们的目的是描述儿童慢性肾脏病研究（CKiD）中的LV GLS，并研究血压（BP）与LV GLS降低之间的关联。
采用单一的心尖四腔心切面来估计LV GLS。我们的主要分析研究了诊室血压与LV GLS绝对值以及在16处二分的LV GLS之间的关联。还使用24小时动态血压监测数据进行了敏感性分析。使用广义估计方程来考虑个体内相关性，并估计95%置信区间的稳健标准误。调整模型中的协变量包括：年龄、性别、种族、估计的肾小球滤过率、尿蛋白、血红蛋白、左心室肥厚以及肾素 - 血管紧张素系统抑制剂的使用。
对962人次进行了LV GLS测量。共有77次评估的LV GLS <16。在调整模型中，诊室收缩压（优势比，1.02 [95%置信区间，1.01 - 1.03]）和舒张压（优势比，1.02 [95%置信区间，1.00 - 1.03]）百分位数均与LV GLS <16相关。动态血压监测显示清醒或夜间舒张压高血压与LV GLS绝对值较低显著相关。
诊室收缩压和舒张压高血压与LV GLS降低有关。动态血压监测中仅检测到的舒张压高血压与较低的LV GLS相关。
