通过左心室整体纵向应变评估的左心室收缩功能障碍在左心室射血分数保留的血液透析患者与高血压性左心室肥厚患者中的回顾性比较。
Retrospective comparison of left ventricular systolic dysfunction assessed by left ventricular global longitudinal strain in hemodialysis patients with preserved left ventricular ejection fraction and patients with hypertensive left ventricular hypertrophy.
作者信息
Ohno Michiya, Segawa Tomonori, Noda Tetsuo, Yasuda Yoshinari, Yamamoto Junichiro
机构信息
Division of Nephrology, Department of Internal Medicine, Asahi University Hospital, 3-23 Hashimoto-cho, Gifu City, Gifu, 500-8523, Japan.
Division of Cardiology, Department of Internal Medicine, Asahi University Hospital, Gifu City, Gifu, Japan.
出版信息
BMC Nephrol. 2025 Jul 31;26(1):425. doi: 10.1186/s12882-025-04368-w.
BACKGROUND
Multiple factors, including hypertension, affect left ventricular remodeling in hemodialysis (HD) patients. Therefore, this retrospective study used left ventricular global longitudinal strain (GLS), an excellent method for detecting mild left ventricular systolic dysfunction, to compare left ventricular systolic function in HD patients with preserved left ventricular ejection fraction (LVEF) and patients with hypertensive left ventricular hypertrophy (HLVH).
METHODS
Participants were aged 60 years or older and had an LVEF of 60% or higher. We compared 20 HD patients (HD group) with 20 HLVH patients matched for age and sex (HLVH group) and 20 healthy control individuals (C group). GLS decline was defined as a GLS value greater than the GLS reference value, which was the mean value of + 2×standard deviation in the C group.
RESULTS
LVEF was not significantly different between the 3 groups, but GLS was significantly worse in the HD group (-15.8%±1.4%) than in the C group (-19.3%±1.1%, p < 0.01) and HLVH group (-17.0%±1.4%, p < 0.05). Relative wall thickness (RWT) and left ventricular mass index (LVMI) were significantly higher in the HLVH and HD groups than in the C group (p < 0.01), and hemoglobin (Hb) levels were significantly lower in the HD group than in the C and HLVH groups (p < 0.01). The frequency of GLS decline (i.e., GLS > -17.0%) was significantly higher in the HD group than in the HLVH group (p < 0.01). Multiple regression analysis of the 3 groups showed that increased RWT and LVMI and decreased Hb were significantly associated with GLS decline (p < 0.01).
CONCLUSIONS
HD patients with preserved LVEF have a significantly greater decline in GLS than HLVH patients. Increased RWT and LVMI with renal anemia may contribute to GLS decline in HD patients with LVEF.
CLINICAL TRIAL NUMBER
2023-01-02.
背景
包括高血压在内的多种因素会影响血液透析（HD）患者的左心室重构。因此，本回顾性研究采用左心室整体纵向应变（GLS）这一检测轻度左心室收缩功能障碍的优秀方法，比较左心室射血分数（LVEF）保留的HD患者和高血压性左心室肥厚（HLVH）患者的左心室收缩功能。
方法
参与者年龄在60岁及以上，LVEF为60%或更高。我们比较了20例HD患者（HD组）、20例年龄和性别匹配的HLVH患者（HLVH组）以及20例健康对照个体（C组）。GLS下降定义为GLS值大于GLS参考值，该参考值为C组中+2×标准差的平均值。
结果
三组间LVEF无显著差异，但HD组（-15.8%±1.4%）的GLS显著差于C组（-19.3%±1.1%，p<0.01）和HLVH组（-17.0%±1.4%，p<0.05）。HLVH组和HD组的相对室壁厚度（RWT）和左心室质量指数（LVMI）显著高于C组（p<0.01），HD组的血红蛋白（Hb）水平显著低于C组和HLVH组（p<0.01）。HD组GLS下降（即GLS>-17.0%）的频率显著高于HLVH组（p<0.01）。三组的多元回归分析表明，RWT和LVMI增加以及Hb降低与GLS下降显著相关（p<0.01）。
结论
LVEF保留的HD患者的GLS下降显著大于HLVH患者。RWT和LVMI增加以及肾性贫血可能导致LVEF保留的HD患者的GLS下降。
临床试验编号
2023 - 01 - 02。
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