Fu Yi-Tsang, Tseng Chih-Hsueh, Huang Wei-Min, Yu Wen-Chung, Cheng Hao-Min, Chiang Chern-En, Chen Chen-Huan, Sung Shih-Hsien, Lin Chih-Ching
Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Department of Internal Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Sci Rep. 2025 Jul 9;15(1):24723. doi: 10.1038/s41598-025-97569-0.
Left ventricular dysfunction is a known risk factor for morbidity and mortality in hemodialysis patients. The prognostic value of left ventricular global longitudinal strain (LV GLS) among those with preserved left ventricular ejection fraction (LVEF) remains uncertain. Subjects with end-stage renal disease initiated hemodialysis at Taipei Veteran General Hospital between 2015 and 2018 were registered. All participants received annually echocardiographic studies thereafter. Left ventricular end-systolic volume (LVESV), end-diastolic volume (LVEDV) and internal diameter in systole (LVIDs), LVEF, and LV GLS were measured. A LV GLS of > - 15.9% was defined as reduced LV GLS. Clinical outcomes of mortality and hospitalization for heart failure (HHF) were followed. A total of 319 patients with preserved LVEF (66.3 ± 15.1 years, 48.6% men) were recruited in the study. Subjects with reduced LV GLS had more coronary artery disease (CAD), higher LVESV and LVIDs, but were similar in age, gender, co-morbidities, biochemistries and other echocardiographic parameters as the counterpart. Both CAD [(odds ratio (OR) and 95% confidence intervals (CIs): 1.669, 1.023-2.724], and LVESV (OR per-1 mL and 95% CIs: 1.073, 1.004-1.146) were independent determinants of reduced LV GLS. Kaplan-Meier analysis indicated that patients with reduced LV GLS had a significantly lower event-free survival rate compared to those with preserved GLS. The multivariate Cox regression analysis further demonstrated LV GLS as a significant predictor of adverse clinical events (hazard ratio per-1% and 95% CIs: 1.055, 1.002-1.110) after accounting for age, gender, and diabetes. Among the hemodialysis patients with preserved LVEF, LV GLS but not the conventional left ventricular functional indices were associated with long-term mortality and HHF. CAD could be a modifiable risk factor among the subjects with reduced LV GLS.
左心室功能障碍是血液透析患者发病和死亡的已知危险因素。左心室射血分数（LVEF）保留的患者中，左心室整体纵向应变（LV GLS）的预后价值仍不确定。登记了2015年至2018年期间在台北荣民总医院开始进行血液透析的终末期肾病患者。此后，所有参与者每年接受超声心动图检查。测量左心室收缩末期容积（LVESV）、舒张末期容积（LVEDV）、收缩期内径（LVIDs）、LVEF和LV GLS。LV GLS＞-15.9%被定义为LV GLS降低。随访死亡和心力衰竭住院（HHF）的临床结局。本研究共纳入319例LVEF保留的患者（66.3±15.1岁，48.6%为男性）。LV GLS降低的患者冠状动脉疾病（CAD）更多，LVESV和LVIDs更高，但在年龄、性别、合并症、生化指标和其他超声心动图参数方面与对照组相似。CAD（比值比（OR）和95%置信区间（CIs）：1.669，1.023-2.724）和LVESV（每增加1 mL的OR和95% CIs：1.073，1.004-1.146）都是LV GLS降低的独立决定因素。Kaplan-Meier分析表明，与GLS保留的患者相比，LV GLS降低的患者无事件生存率显著降低。多变量Cox回归分析进一步表明，在考虑年龄、性别和糖尿病因素后，LV GLS是不良临床事件的重要预测因子（每降低1%的风险比和95% CIs：1.055，1.002-1.110）。在LVEF保留的血液透析患者中，与长期死亡率和HHF相关的是LV GLS，而不是传统的左心室功能指标。CAD可能是LV GLS降低患者中一个可改变的危险因素。
