Goeddel Lee A, Navarrete Sergio, Waldron Natalie, D'Amiano Anjali, Faraday Nauder, Lima Joao A C, Parikh Chirag R, Bandeen-Roche Karen, Hays Allison G, Brown Iv Charles
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Anesthesiology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA.
Cardiology. 2024 Oct 1:1-11. doi: 10.1159/000541725.
Cardiac function is important to quantify for risk stratification. Although left ventricular ejection fraction (LVEF) is commonly used, and identifies patients with poor systolic function, other easily acquired measures of cardiac function are needed, particularly to stratify patients with relatively preserved LVEF. LV relative wall thickness (RWT) has been associated with adverse clinical outcomes in patients with preserved LVEF, but the clinical relevance of this observation is not known. The purpose of this study was to assess whether increased RWT is a marker of subclinical cardiac dysfunction as measured by a surrogate of LV dysfunction and left ventricular ejection time (LVET) and if increased RWT is independently associated with chronic kidney disease (CKD), an important clinical outcome and cardiovascular disease risk equivalent.
This retrospective cohort study enrolled ambulatory patients 18 years and older undergoing routine transthoracic echocardiography (TTE) at Johns Hopkins Hospital from January 2017 to January 2018. Patients with LVEF <50%, severe valvular disease, or liver failure were excluded. Multivariable regression evaluated the relationship between RWT, LVET, and CKD adjusted for demographics, comorbidities, and vital signs.
We analyzed data from 375 patients with mean age (±SD) 52.2 ± 15.3 years of whom 58% were female. Mean ± SD of RWT was 0.45 ± 0.10, while mean ± SD of LVET was 270 ms ± 33. In multivariable linear regression adjusted for demographics, comorbidities, vital signs, and left ventricular mass, each 0.1 increase in RWT was associated with a decrease of 4.6 ms in LVET, indicating worse cardiac function (β, ± 95% CI) (-4.60, -7.37 to -1.48, p = 0.004). Of those with serum creatinine available 1 month before or after TTE, 20% (50/247) had stage 3 or greater CKD. In logistic regression (adjusted for sex, comorbidities, and medications), each 0.1 unit increase in RWT was associated with an 61% increased odds of CKD (aOR = 1.61, 1.03-2.53, p = 0.037). In multivariable ordinal regression adjusted for the same covariates, each 0.1 unit increase in RWT was associated with a 44% increased odds of higher CKD stage (aOR = 1.44, 1.03-2.02, p = 0.035). There was a trend but no statistically significant relationship between RWT and change in estimated glomerular filtration rate at 1 year.
In an outpatient cohort undergoing TTE, increased RWT was independently associated with a surrogate of subclinical systolic dysfunction (LVET) and CKD. This suggests that RWT, an easily derived measure of LV geometry on TTE, may identify clinically relevant subclinical systolic dysfunction and patients with worse kidney function. Additional investigation to further clarify the relationships between RWT, systolic function, and kidney dysfunction over time and how this information may guide clinical intervention are warranted.
心脏功能的量化对于风险分层很重要。虽然左心室射血分数（LVEF）常用且能识别收缩功能不佳的患者，但还需要其他易于获取的心脏功能测量指标，特别是用于对LVEF相对保留的患者进行分层。左心室相对壁厚度（RWT）与LVEF保留患者的不良临床结局相关，但这一观察结果的临床相关性尚不清楚。本研究的目的是评估RWT增加是否是以左心室功能障碍替代指标和左心室射血时间（LVET）衡量的亚临床心脏功能障碍的标志物，以及RWT增加是否与慢性肾脏病（CKD）独立相关，CKD是一项重要的临床结局和心血管疾病风险等同因素。
这项回顾性队列研究纳入了2017年1月至2018年1月在约翰霍普金斯医院接受常规经胸超声心动图（TTE）检查的18岁及以上门诊患者。排除LVEF<50%、严重瓣膜病或肝功能衰竭患者。多变量回归评估了在调整人口统计学、合并症和生命体征后RWT、LVET和CKD之间的关系。
我们分析了375例患者的数据，平均年龄（±标准差）为52.2±15.3岁，其中58%为女性。RWT的平均值±标准差为0.45±0.10，而LVET的平均值±标准差为270毫秒±33。在调整了人口统计学、合并症、生命体征和左心室质量的多变量线性回归中，RWT每增加0.1与LVET减少4.6毫秒相关，表明心脏功能更差（β，±95%置信区间）（-4.60，-7.37至-1.48，p=0.004）。在TTE前或后1个月有血清肌酐数据的患者中，20%（50/247）患有3期或更严重的CKD。在逻辑回归（调整了性别、合并症和药物治疗）中，RWT每增加0.1个单位与CKD的患病几率增加61%相关（调整后比值比[aOR]=1.61，1.03-2.53，p=0.037）。在调整了相同协变量的多变量有序回归中，RWT每增加0.1个单位与更高CKD分期的患病几率增加44%相关（aOR=1.44，1.03-2.02，p=0.035）。RWT与1年时估计肾小球滤过率的变化之间存在趋势但无统计学显著关系。
在接受TTE检查的门诊队列中，RWT增加与亚临床收缩功能障碍替代指标（LVET）和CKD独立相关。这表明RWT是TTE上易于获得的左心室几何形状测量指标，可能识别出临床相关的亚临床收缩功能障碍和肾功能较差的患者。有必要进行进一步研究以更清楚地阐明RWT、收缩功能和肾功能障碍随时间的关系，以及这些信息如何指导临床干预。
