eGFR Trajectory in LVAD Recipients with Right Heart Failure: Status Quo or a Steady Decline?
eGFR Trajectory in LVAD Recipients with Right Heart Failure: Status Quo or a Steady Decline?
复制标题
患有右心衰竭的 LVAD 接受者的 eGFR 轨迹：现状还是稳步下降？
DOI：
10.1161/jaha.124.033925
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发表时间：
2024
影响因子：
5.4
通讯作者：
Agdamag,ArianneC
中科院分区：
文献类型：
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作者：
Roehm,Bethany;Agdamag,ArianneC
左心室辅助装置（LVAD）植入后两个特别可怕的结局是右心衰竭（RHF）和肾功能恶化。然而，无论好坏，右心功能和肾功能天生交织在一起（图）。静脉回流增加、左心室（LV）卸载、全身后负荷变化、术中因素、慢性心力衰竭（HF）对右心室功能的影响以及LVAD缝入LV后心室扭转方式的构象变化均可能导致术后RHF的发生。1慢性肾脏疾病本身可能通过降低肾小球滤过率（GFR）、肾小管功能障碍、肾素-血管紧张素-醛固酮系统激活以及可能的其他机制（如尿毒症毒素积聚和FGF-23水平升高）促进RHF的发生。2-5 RHF可能主要通过体静脉压升高对肾功能产生不利影响，从而导致一系列下游效应，最终导致GFR降低和利尿效率降低，其中心脏充盈不足可能发挥更小的作用。六、七
Two outcomes particularly dreaded after left ven-tricular assist device (LVAD) implantation are development of right heart failure (RHF) and worsening kidney function. Yet for better or worse, right heart function and kidney function are innately intertwined (Figure). Increased venous return, left ventricular (LV) unloading, changes in systemic afterload, intraoperative factors, the effects of chronic heart failure (HF) on right ventricular function, and conformational changes in how ventricles twist as a result of LVAD being sewn into LV can all contribute to the development of postoperative RHF. 1 Chronic kidney disease itself may contribute to the development of RHF via reduced glomerular filtration rate (GFR), tubular dysfunction, renin-angiotensin-aldosterone system activation, and possibly other mechanisms such as uremic toxin build-up and higher FGF-23 levels. 2–5 RHF may adversely affect kidney function predominantly through elevated systemic venous pressure, which leads to a cascade of downstream effects all culminating in reduced GFR and reduced diuretic efficiency, with cardiac underfilling likely playing a more minor role. 6, 7