Impaired Retinal Vessel Dilation Predicts Mortality in End-Stage Renal Disease
Impaired Retinal Vessel Dilation Predicts Mortality in End-Stage Renal Disease
复制标题
视网膜血管扩张受损可预测终末期肾病的死亡率
DOI：
10.1161/circresaha.118.314318
复制
发表时间：
2019-06-07
影响因子：
20.1
通讯作者：
Schmadere, Christoph
中科院分区：
文献类型：
--
作者：
Guenthner, Roman;Hanssen, Henner;Schmadere, Christoph
基本原理：终末期肾病患者的特点是心血管和全因死亡率增加，因为大血管和微血管床的晚期重塑。目的：本研究的目的是确定视网膜微血管功能是否可以预测终末期肾病患者的全因和心血管死亡率。方法和结果：在多中心前瞻性观察性ISAR研究（终末期肾病风险分层）中，214例透析患者（平均年龄62.6 ± 15.0岁; 32%为女性）的子队列中提供了动态视网膜血管分析数据。通过测量视网膜血管响应闪烁光刺激的最大小动脉扩张和最大小静脉扩张（vMax）来量化微血管功能障碍。在平均44个月的随访中，55名患者死亡，包括25例心血管和30例非心血管致死性事件。vMax成为全因死亡率的一个强有力的独立预测因素。在Kaplan-Meier分析中，vMax最低三分位数内的个体显示出比最高三分位数内的个体显著更短的3年生存率（66.9 +/- 5.8% vs 92.4 +/- 3.3%）。vMax每SD增加的全因死亡率的单变量和多变量风险比分别为0.62（0.47-0.82）和0.65（0.47-0.91）。最大小动脉扩张和vMax能够显著预测非致死性和致死性心血管事件（风险比分别为0.74 [0.57-0.97]和0.78 [0.61-0.99]）。结论：我们的研究结果提供了第一个证据，即视网膜小静脉扩张受损是血液透析终末期肾病患者全因死亡率的一个强有力的独立预测因素。动态视网膜血管分析为预测全因死亡率提供了附加值，并可能成为一种新的诊断工具，以优化终末期肾病和其他高风险心血管队列的心血管风险分层。
Rationale: Patients with end-stage renal disease are characterized by increased cardiovascular and all-cause mortality because of advanced remodeling of the macrovascular and microvascular beds. Objective: The aim of this study was to determine whether retinal microvascular function can predict all-cause and cardiovascular mortality in patients with end-stage renal disease. Methods and Results: In the multicenter prospective observational ISAR study (Risk Stratification in End-Stage Renal Disease), data on dynamic retinal vessel analysis were available in a subcohort of 214 dialysis patients (mean age, 62.6 +/- 15.0; 32% women). Microvascular dysfunction was quantified by measuring maximum arteriolar dilation and maximum venular dilation (vMax) of retinal vessels in response to flicker light stimulation. During a mean follow-up of 44 months, 55 patients died, including 25 cardiovascular and 30 noncardiovascular fatal events. vMax emerged as a strong independent predictor for all-cause mortality. In the Kaplan-Meier analysis, individuals within the lowest tertile of vMax showed significantly shorter 3-year survival rates than those within the highest tertile (66.9 +/- 5.8% versus 92.4 +/- 3.3%). Univariate and multivariate hazard ratios for all-cause mortality per SD increase of vMax were 0.62 (0.47-0.82) and 0.65 (0.47-0.91), respectively. Maximum arteriolar dilation and vMax were able to significantly predict nonfatal and fatal cardiovascular events (hazard ratio, 0.74 [0.57-0.97] and 0.78 [0.61-0.99], respectively). Conclusions: Our results provide the first evidence that impaired retinal venular dilation is a strong and independent predictor of all-cause mortality in hemodialyzed end-stage renal disease patients. Dynamic retinal vessel analysis provides added value for prediction of all-cause mortality and may be a novel diagnostic tool to optimize cardiovascular risk stratification in end-stage renal disease and other high-risk cardiovascular cohorts.