Song Sisi, Xie Linjun, Xu Huayan, Xu Ke, Fu Hang, Zhang Lu, Hou Ruilai, Tao Yuhong, Guo Yingkun
Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, China.
Key Laboratory of Birth Defects and Related Diseases of Women and Children, (Sichuan University), Ministry of Education, Chengdu, China.
BMC Cardiovasc Disord. 2024 Oct 1;24(1):526. doi: 10.1186/s12872-024-04179-1.
Children with chronic kidney disease (CKD) are at high risk of cardiovascular disease. Cardiovascular magnetic resonance (CMR) is the reference method for assessing cardiac remodeling. To our knowledge, no study has reported a comprehensive analysis of left ventricular(LV) cardiac remodeling using CMR in different stages of pediatric CKD. This prospective case-control study aimed to investigate cardiac remodeling in pediatric CKD, using CMR, and determine its relationship with risk factors.
CMR was performed in 124 children with CKD and 50 controls. The cardiac remodeling parameters included left ventricular mass index (LVMI), LV remodeling index (LVRI), and LV wall thickness. Univariable and multivariable analyses were performed to assess the cardiac remodeling risk factors.
Cardiac remodeling was observed in 35.5% (44/124) of children with CKD. The LVMI, LVRI, and LV wall thickness were higher in advanced stages of CKD (P < 0.05). In the CKD stage 1-2 group, a lower in the estimated glomerular filtration rate was an independent determinant of impaired LVMI (β = -0.425, P = 0.019) and LVRI (β = -0.319, P = 0.044). A higher protein to creatinine ratio(PCR) was independently associated with impaired LVRI (β = 0.429, P = 0.022). In the CKD stage 3-5 group, higher in systolic blood pressure (SBP) (β = 0.464, P = 0.005) and PCR (β = 0.852, P = 0.031) were independent determinants of impaired LVMI. Additionally, higher SBP was positively correlated with impaired LVRI(r = 0.599, P < 0.001). There was a trend toward more abnormal cardiac remodeling in the CKD stage 3-5 group with hypertension than those without.
Cardiac remodeling is prevalent in children with CKD, from an early stage. kidney markers are independently associated with cardiac remodeling. Hypertension increases the risk of cardiac remodeling in CKD stages 3-5. Strict BP control may help reverse or prevent remodeling.
慢性肾脏病（CKD）患儿患心血管疾病的风险很高。心血管磁共振成像（CMR）是评估心脏重塑的参考方法。据我们所知，尚无研究报道使用CMR对小儿CKD不同阶段的左心室（LV）心脏重塑进行全面分析。这项前瞻性病例对照研究旨在使用CMR调查小儿CKD的心脏重塑情况，并确定其与危险因素的关系。
对124例CKD患儿和50例对照者进行CMR检查。心脏重塑参数包括左心室质量指数（LVMI）、左心室重塑指数（LVRI）和左心室壁厚度。进行单变量和多变量分析以评估心脏重塑的危险因素。
在35.5%（44/124）的CKD患儿中观察到心脏重塑。CKD晚期患儿的LVMI、LVRI和左心室壁厚度更高（P<0.05）。在CKD 1-2期组中，估计肾小球滤过率降低是LVMI受损（β=-0.425，P=0.019）和LVRI受损（β=-0.319，P=0.044）的独立决定因素。较高的蛋白肌酐比值（PCR）与LVRI受损独立相关（β=0.429，P=0.022）。在CKD 3-5期组中，较高的收缩压（SBP）（β=0.464，P=0.005）和PCR（β=0.852，P=0.031）是LVMI受损的独立决定因素。此外，较高的SBP与LVRI受损呈正相关（r=0.599，P<0.001）。与无高血压的CKD 3-5期组相比，有高血压的CKD 3-5期组心脏重塑异常的趋势更明显。
心脏重塑在CKD患儿中从早期就普遍存在。肾脏指标与心脏重塑独立相关。高血压增加了CKD 3-5期心脏重塑的风险。严格控制血压可能有助于逆转或预防重塑。
