Echocardiographic Assessment of the Cardio-Renal Connection: Is Left Ventricular Hypertrophy or Diastolic Function More Closely Correlated with Estimated Glomerular Filtration Rate in Patients with Cardiovascular Risk Factors?
Echocardiographic Assessment of the Cardio-Renal Connection: Is Left Ventricular Hypertrophy or Diastolic Function More Closely Correlated with Estimated Glomerular Filtration Rate in Patients with Cardiovascular Risk Factors?
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DOI：
10.3109/10641960902993145
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发表时间：
2010-04
影响因子：
12.3
通讯作者：
H. Masugata;S. Senda;F. Goda;Ayumu Yamagami;Hiroyuki Okuyama;Takeaki Kohno;N. Hosomi;K. Yukiiri;T. Noma;M. Imai;H. Kiyomoto;A. Nishiyama;M. Kohno
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文献类型：
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作者：
H. Masugata;S. Senda;F. Goda;Ayumu Yamagami;Hiroyuki Okuyama;Takeaki Kohno;N. Hosomi;K. Yukiiri;T. Noma;M. Imai;H. Kiyomoto;A. Nishiyama;M. Kohno
虽然通过超声心动图和慢性肾脏疾病（CKD）评估左室（LV）肥厚和舒张功能已被确立为高血压患者心血管事件的预测因素，但超声心动图参数与肾功能之间的关系尚未得到充分研究。我们研究了在有心血管危险因素的患者中，超声心动图参数与肾小球滤过率（eGFR）的相关性最好。研究纳入309例有心血管危险因素的患者（平均年龄67±13岁）。超声心动图测量左室质量指数（LVMI）作为左室肥厚的指标。测定左室舒张功能的指标为早房传递速度（E/A）比和早舒张尖峰二尖瓣环速度（E’）。E/E’作为低压预载参数计算。eGFR的测量采用日本肾脏学会提出的公式。LVMI （r = - 0.333, p < 0.001）和高血压（r = - 0.326, p < 0.001）与eGFR的相关性较E′（r = 0.276, p < 0.001）和E/A （r = 0.224, p < 0.001）更接近。逐步回归分析显示，高血压（β系数= - 0.211,p < 0.001）和LVMI （β系数= - 0.206,p < 0.001）与eGFR独立相关。E/E′随eGFR的降低而升高，且CKD 5期E/E′（16.0±6.8）显著高于eGFR≥90 mL/min/1.73 m2组（10.5±4.5）（p < 0.001）。由于CKD阶段的进展，左室预负荷的增加可能影响左室舒张功能。因此，使用超声心动图预测CKD患者低eGFR时，左室肥厚可能优于左室舒张功能障碍。
Although left ventricular (LV) hypertrophy and diastolic function assessed by echocardiography and chronic kidney disease (CKD) have been established as predictors of cardiovascular events in hypertensive patients, the relationships between the echocardiographic parameters and renal function have not been fully examined. We examined which echocardiographic parameter correlates best with estimated glomerular filtration rate (eGFR) in patients with cardiovascular risk factors. Enrolled in the study were 309 patients (mean age 67 ± 13 y) with cardiovascular risk factors. Echocardiography was performed to measure left ventricular mass index (LVMI) as an index of LV hypertrophy. Transmitral early to atrial velocity (E/A) ratio and peak early diastolic mitral annular velocity (E′) were measured as indexes of LV diastolic function. E/E′ was calculated as a parameter of LV preload. eGFR was measured using the equation proposed by the Japanese Society of Nephrology. The correlations of LVMI (r = −0.333, p < 0.001) and hypertension (r = −0.326, p < 0.001) to eGFR were closer than those of E′ (r = 0.276, p < 0.001) and E/A (r = 0.224, p < 0.001) to eGFR. Stepwise regression analysis showed that hypertension (β coefficient = −0.211, p < 0.001) and LVMI (β coefficient = −0.206, p < 0.001) were independently associated with eGFR. The E/E′ increased with a decrease in eGFR, and E/E′ in CKD stage 5 (16.0 ± 6.8) was significantly higher than that in patients in whom eGFR ≥ 90 mL/min/1.73 m2 (10.5 ± 4.5) (p < 0.001). Left ventricular diastolic function may be influenced by the increase in LV preload due to progression of CKD stage. Therefore, LV hypertrophy may be superior to LV diastolic dysfunction in predicting low eGFR in patients with CKD using echocardiography.