Li Qingkuan, Qiu Lingyue, Long Meiying, Zeng Huayuan, Lu Zhihong, Liu Ling, Lin Yingzhong, Ye Kun, Qin Shaoming, Wu Qiuxia, Ji Qingwei
Jinan University, Guangzhou, 510632, China.
Guangxi Chest Pain Center, Department of Cardiology, Institute of Cardiovascular Diseases, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, 530000, China.
BMC Nephrol. 2025 Jul 12;26(1):384. doi: 10.1186/s12882-025-04316-8.
BACKGROUND: Patients with end-stage renal disease (ESRD) face a significantly elevated risk of cardiovascular morbidity and mortality, with left ventricular (LV) systolic dysfunction and heart failure (HF) being major contributors. Reduced left ventricular ejection fraction (LVEF) defines LV systolic dysfunction and is closely linked to adverse outcomes. This study aimed to assess the prevalence of abnormal LVEF in ESRD patients receiving hemodialysis and to examine the prognostic significance of varying LVEF levels on mortality and cardiovascular outcomes. METHODS AND RESULTS: A retrospective cohort study was conducted on 1,019 ESRD patients receiving hemodialysis at People's Hospital of Guangxi Zhuang Autonomous Region between January 1, 2020, and December 31, 2021. Based on baseline LVEF, patients were classified into three groups: reduced ejection fraction (LVEF ≤ 40%, rEF), mildly reduced ejection fraction (LVEF 41-49%, mrEF), and normal ejection fraction (LVEF ≥ 50%, nEF). Clinical outcomes, including all-cause mortality and major adverse cardiovascular events (MACEs), were analyzed to assess the impact of LVEF levels. During a median follow-up of 35 months (IQR, 31-51 months), 214 patients (21.0%) died, and 218 (21.4%) experienced MACEs. The prevalence of abnormal LVEF was 13.35%, with 7.55% of patients in the mrEF group and 5.80% in the rEF group. Patients with abnormal LVEF showed significantly higher rates of all-cause mortality and MACEs than those with normal LVEF. In the rEF group, the odds ratios (ORs) for all-cause mortality and MACEs were 2.91 (95% CI: 1.83-4.63, P < 0.001) and 4.76 (95% CI: 2.43-9.46, P < 0.001), respectively. In the mrEF group, ORs for all-cause mortality and MACEs were 1.69 (95% CI: 1.09-2.62, P = 0.019) and 2.68 (95% CI: 1.54-4.68, P < 0.001), respectively. CONCLUSION: Abnormal LVEF is prevalent in ESRD patients on hemodialysis and is strongly associated with increased risks of all-cause mortality and MACEs. Lower LVEF levels correlate with poorer outcomes, underscoring the importance of early detection and targeted management strategies to improve prognosis in this high-risk population.
背景：终末期肾病（ESRD）患者面临心血管疾病发病率和死亡率显著升高的风险，左心室（LV）收缩功能障碍和心力衰竭（HF）是主要原因。左心室射血分数（LVEF）降低定义为LV收缩功能障碍，且与不良结局密切相关。本研究旨在评估接受血液透析的ESRD患者中LVEF异常的患病率，并探讨不同LVEF水平对死亡率和心血管结局的预后意义。 方法与结果：对2020年1月1日至2021年12月31日在广西壮族自治区人民医院接受血液透析的1019例ESRD患者进行了一项回顾性队列研究。根据基线LVEF，患者被分为三组：射血分数降低（LVEF≤40%，rEF）、轻度射血分数降低（LVEF 41 - 49%，mrEF）和射血分数正常（LVEF≥50%，nEF）。分析包括全因死亡率和主要不良心血管事件（MACE）在内的临床结局，以评估LVEF水平的影响。在中位随访35个月（四分位间距，31 - 51个月）期间，214例患者（21.0%）死亡，218例（21.4%）发生MACE。LVEF异常的患病率为13.35%，mrEF组患者占7.55%，rEF组患者占5.80%。LVEF异常的患者全因死亡率和MACE发生率显著高于LVEF正常的患者。在rEF组中，全因死亡率和MACE的比值比（OR）分别为2.91（95%CI：1.83 - 4.63，P < 0.001）和4.76（95%CI：2.43 - 9.46，P < 0.001）。在mrEF组中，全因死亡率和MACE的OR分别为1.69（95%CI：1.09 - 2.62，P = 0.019）和2.68（95%CI：1.54 - 4.68，P < 0.001）。 结论：LVEF异常在接受血液透析的ESRD患者中普遍存在，且与全因死亡率和MACE风险增加密切相关。较低的LVEF水平与较差的结局相关，强调了早期检测和针对性管理策略对改善这一高危人群预后的重要性。
Cochrane Database Syst Rev. 2021-11-5
Cochrane Database Syst Rev. 2018-6-28
Eur Heart J. 2025-6-16
Eur Heart J. 2021-9-21
J Am Coll Cardiol. 2021-3-23
Kidney Int Suppl (2011). 2017-10
Front Med (Lausanne). 2018-7-24
Zotero 插件