Vieira Demétrio C S, Santos Agnes N, Ribeiro Vinicius C, Bezerra Rodrigo, Feitosa Audes D M, Sposito Andrei C, Matos-Souza José R, Mazzali Marilda, Nadruz Wilson
Department of Internal Medicine, School of Medical Sciences, State University of Campinas, São Paulo, SP, Brazil.
Pronto Socorro Cardiológico de Pernambuco (PROCAPE), University of Pernambuco, Recife, PE, Brazil.
Curr Med Res Opin. 2025 May;41(5):753-759. doi: 10.1080/03007995.2025.2517699. Epub 2025 Jun 13.
Left ventricular (LV) hypertrophy (LVH) and dysfunction are key contributors to the increased cardiovascular risk and are related to increased carotid intima-media thickness (cIMT) in hemodialysis (HD) patients. Although cIMT is considered a marker of atherosclerosis, examining its components - the intimal layer (cIT, associated with atherosclerosis) and the medial layer (cMT, linked to arteriosclerosis) - may provide deeper insights into the mechanisms of its association with LV remodeling. This study aimed to evaluate the relationship between carotid wall sublayers and LV alterations in HD patients.
This cross-sectional study evaluated 102 HD patients who underwent high-resolution ultrasound to evaluate cIMT, cIT, cMT, cIT/cMT ratio, and carotid plaques. LVH, LV geometric patterns, and LV diastolic dysfunction (E/e' > 14) and systolic dysfunction (global longitudinal strain [GLS] > -16% or LV ejection fraction [LVEF] < 50%) were evaluated using echocardiography.
The studied sample had age = 57 ± 15 years, 59% males and median HD vintage = 17 [2, 36] months. Multivariable logistic regression analyses showed that LVH was associated with cIT (OR [95% CI] = 1.73 [1.13-2.67], = .012), cIT/cMT ratio (OR [95% CI] = 1.24 [1.04-1.49], = .015) and cIMT (OR [95% CI] = 1.41 [1.03-1.93], = .031). Regarding LV geometric patterns, results of adjusted analyses showed that eccentric LVH was associated with cIT (OR [95% CI] = 1.64 [1.06-2.54], = .027) and cIT/cMT ratio (OR [95% CI] = 1.25 [1.03-1.51]; = .023). Conversely, E/e' > 14, GLS > -16% and LVEF < 50% showed no independent association with any carotid parameter.
cIT and cIT/cMT ratio were more closely associated with LVH and eccentric LVH than cIMT or cMT in HD patients, suggesting they may be potential novel markers of cardiovascular risk in this population.
左心室（LV）肥厚（LVH）和功能障碍是心血管风险增加的关键因素，并且与血液透析（HD）患者颈动脉内膜中层厚度（cIMT）增加有关。尽管cIMT被认为是动脉粥样硬化的标志物，但检查其组成部分——内膜层（cIT，与动脉粥样硬化相关）和中层（cMT，与动脉硬化相关）——可能会更深入地了解其与左心室重塑相关的机制。本研究旨在评估HD患者颈动脉壁各层与左心室改变之间的关系。
这项横断面研究评估了102例接受高分辨率超声检查以评估cIMT、cIT、cMT、cIT/cMT比值和颈动脉斑块的HD患者。使用超声心动图评估LVH、左心室几何形态、左心室舒张功能障碍（E/e' > 14）和收缩功能障碍（整体纵向应变[GLS] > -16%或左心室射血分数[LVEF] < 50%）。
研究样本的年龄为57±15岁，男性占59%，HD中位病程为17[2, 36]个月。多变量逻辑回归分析显示，LVH与cIT（比值比[95%置信区间]=1.73[1.13 - 2.67]，P = 0.012）、cIT/cMT比值（比值比[95%置信区间]=1.24[1.04 - 1.49]，P = 0.015）和cIMT（比值比[95%置信区间]=1.41[1.03 - 1.93]，P = 0.031）相关。关于左心室几何形态，校正分析结果显示，离心性LVH与cIT（比值比[95%置信区间]=1.64[1.06 - 2.54]，P = 0.027）和cIT/cMT比值（比值比[95%置信区间]=1.25[1.03 - 1.51]；P = 0.023）相关。相反，E/e' > 14、GLS > -16%和LVEF < 50%与任何颈动脉参数均无独立相关性。
在HD患者中，cIT和cIT/cMT比值与LVH和离心性LVH的相关性比cIMT或cMT更密切,表明它们可能是该人群心血管风险的潜在新标志物。
