Porras Cindy P, Dal Canto Elisa, van Ommen Anne-Mar L, Handoko M Louis, Haitjema Saskia, de Groot Mark C H, Bots Michiel L, Verhaar Marianne C, Vernooij Robin W M
Department of Nephrology and Hypertension, University Medical Center Utrecht, Room F03.204, Heidelberglaan 100, Postbus 85500, 3584CX Utrecht, The Netherlands.
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, Postbus 85500, 3584CX Utrecht, The Netherlands.
J Clin Med. 2024 Sep 8;13(17):5313. doi: 10.3390/jcm13175313.
Left ventricular diastolic dysfunction (LVDD) commonly coexists with kidney dysfunction. In this study, we investigated the presence of abnormalities in echocardiography parameters indicative of LVDD across stages of kidney function. We selected patients who visited a university hospital and had a serum creatinine and echocardiography reported in their medical records. Participants were categorized based on their kidney function: normal (estimated glomerular filtration rate [eGFR] ≥ 90 mL/min/1.73 m), mildly decreased (eGFR: 60-90), moderately decreased (eGFR: 30-60), and severely decreased (eGFR < 30). The relationship between kidney function and echocardiography parameters was examined using logistic and linear regressions. Among 4022 patients (age: 66.5 years [SD: 12.1], 41% women), 26%, 50%, 20%, and 4% had a normal, mildly, moderately, and severely decreased kidney function, respectively. Compared to patients with normal kidney function, patients with mildly decreased kidney function had higher odds for an abnormal E/e' ratio (OR: 1.51 [95% CI: 1.13, 2.02]). Patients with moderately decreased kidney function presented a higher risk of abnormal E/e' (OR: 2.90 [95% CI: 2.08, 4.04]), LAVI (OR: 1.62 [95% CI: 1.13, 2.33]), TR velocity (OR: 2.31 [95% CI: 1.49, 3.57]), and LVMI (OR: 1.70 [95% CI: 1.31, 2.20]), while patients with severely decreased kidney function had higher odds for abnormal E/e' (OR: 2.95 [95% CI: 1.68, 5.17]) and LVMI > 95 g/m in women or >115 g/m in men (OR: 2.07 [95% CI: 1.27, 3.38]). The linear regression showed a significant inverse association between eGFR and echocardiography parameters, meaning that with worse kidney function, the parameters for LVDD worsened as well. Abnormal echocardiography parameters of LVDD were present even in patients with mildly decreased kidney function. As the kidney function worsened, there was a gradual increase in the risk of abnormal parameters of LVDD.
左心室舒张功能障碍（LVDD）常与肾功能障碍并存。在本研究中，我们调查了在肾功能各阶段中提示LVDD的超声心动图参数异常情况。我们选择了就诊于大学医院且病历中有血清肌酐和超声心动图报告的患者。参与者根据肾功能进行分类：正常（估计肾小球滤过率[eGFR]≥90 mL/min/1.73 m²）、轻度降低（eGFR：60 - 90）、中度降低（eGFR：30 - 60）和重度降低（eGFR < 30）。使用逻辑回归和线性回归检验肾功能与超声心动图参数之间的关系。在4022例患者（年龄：66.5岁[标准差：12.1]，41%为女性）中，分别有26%、50%、20%和4%的患者肾功能正常、轻度降低、中度降低和重度降低。与肾功能正常的患者相比，肾功能轻度降低的患者E/e'比值异常的几率更高（比值比：1.51[95%置信区间：1.13，2.02]）。肾功能中度降低的患者出现E/e'异常（比值比：2.90[95%置信区间：2.08，4.04]）、左房容积指数（LAVI）异常（比值比：1.62[95%置信区间：1.13，2.33]）、三尖瓣反流速度（TR速度）异常（比值比：2.31[95%置信区间：1.49，3.57]）和左室质量指数（LVMI）异常（比值比：1.70[95%置信区间：1.31，2.20]）的风险更高，而肾功能重度降低的患者E/e'异常（比值比：2.95[95%置信区间：1.68，5.17]）以及女性LVMI > 95 g/m²或男性LVMI > 115 g/m²的几率更高（比值比：2.07[95%置信区间：1.27，3.38]）。线性回归显示eGFR与超声心动图参数之间存在显著的负相关，这意味着肾功能越差，LVDD的参数也越差。即使在肾功能轻度降低的患者中也存在LVDD的异常超声心动图参数。随着肾功能恶化，LVDD异常参数的风险逐渐增加。
