Defining Biventricular Abnormalities by Cardiac Magnetic Resonance in Pre-Dialysis Patients with Chronic Kidney Disease.

IF 3.2 4区医学 Q1 UROLOGY & NEPHROLOGY

Kidney Diseases Pub Date : 2023-02-13 eCollection Date: 2023-08-01 DOI:10.1159/000529526

Li Qi, Beibei Zhi, Jun Zhang, Lingyan Zhang, Song Luo, Longjiang Zhang

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Abstract

Introduction: The aim of the study was to investigate biventricular structural and functional abnormalities in pre-dialysis patients across stages of chronic kidney disease (CKD) by cardiac magnetic resonance (CMR).

Methods: Fifty-one CKD patients with CMR exams were retrospectively analyzed. Patients were divided into three groups according to estimated glomerular filtration rate (eGFR): CKD 1 group (patients with normal eGFR≥90 mL/min/1.73 m², n = 20), CKD 2-3 group (patients with eGFR< 90 to ≥30 mL/min/1.73 m², n = 14), and CKD 4-5 group (patients with eGFR<30 mL/min/1.73 m², n = 17). Twenty-one age- and sex-matched healthy controls (HC) were recruited. CMR-derived left ventricular (LV) and right ventricular (RV) structural and functional measures were compared. Association between CMR parameters and clinical measures was assessed.

Results: There was an increasing trend in RV mass index (RVMi) and LV mass index (LVMi) with the occurrence and development of CKD from HC group to CKD 4-5 group although no significant difference was observed between CKD 1 group and HC group. LV global radial strain and LV global circumferential strain dropped and native T1 value elevated significantly in CKD 4-5 group compared with the other three groups (all p < 0.05), while RV strain measures, RV ejection fraction, and LV ejection fraction showed no significant difference among 4 groups (all p > 0.05). Elevated LV end-diastolic volume index (β = 0.356, p = 0.016) and RV end-systolic volume index (β = 0.488, p = 0.001) were independently associated with RVMi. Increased systolic blood pressure (β = 0.309, p = 0.004), LV end-systolic volume index (β = 0.633, p < 0.001), and uric acid (β = 0.261, p = 0.013) were independently associated with LVMi. Meanwhile, serum phosphorus (β = 0.519, p = 0.001) was independently associated with native T1 value.

Conclusion: In pre-dialysis CKD patients, left and right ventricular remolding has occurred. RVMi and LVMi were the first changed CMR indexes in the development of CKD when eGFR began to drop. Because fluid volume overload was the independent risk factor for RVMi and LVMi increase, reasonable controlling fluid volume overload may slow down the progression of biventricular remolding and may reduce related cardiovascular disease risk.

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慢性肾脏病透析前患者双心室异常的心脏磁共振诊断。

引言：本研究的目的是通过心脏磁共振（CMR）研究不同阶段慢性肾脏病（CKD）透析前患者的双心室结构和功能异常。方法：回顾性分析51例进行CMR检查的CKD患者。根据估计的肾小球滤过率（eGFR）将患者分为三组：CKD 1组（eGFR<90至≥30 mL/min/1.73 m2的患者，n=20）、CKD 2-3组（e肾小球滤过率<90至>30 mL/mn/1.73 m2患者，n=14）和CKD 4-5组（eEGFR2患者，n=17）。招募了21名年龄和性别匹配的健康对照（HC）。比较CMR衍生的左心室（LV）和右心室（RV）的结构和功能测量。评估了CMR参数与临床测量之间的相关性。结果：从HC组到CKD 4-5组，RV质量指数（RVMi）和LV质量指数（LVMi）随着CKD的发生和发展有增加的趋势，但CKD 1组和HC组之间没有显著差异。与其他三组相比，CKD 4-5组的左心室整体径向应变和左心室整体周向应变下降，固有T1值显著升高（均p<0.05），而RV应变测量、RV射血分数、，左心室射血分数在4组间无显著性差异（均p>0.05）。左心室舒张末期容积指数（β=0.356，p=0.016）和右心室收缩末期容积指数升高（β=0.488，p=0.001）与RVMi独立相关。收缩压升高（β=0.309，p=0.004）、左心室收缩末期容积指数升高（β0.633，p<0.001）和尿酸升高（β0.261，p=0.013）与LVMi独立相关。同时，血清磷（β=0.519，p=0.001）与天然T1值独立相关。结论：透析前CKD患者发生左、右心室重塑。当eGFR开始下降时，RVMi和LVMi是CKD发展过程中第一个改变的CMR指标。由于液体容量过载是RVMi和LVMi增加的独立风险因素，合理控制液体容量过载可以减缓双心室重塑的进展，并可以降低相关的心血管疾病风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Kidney Diseases UROLOGY & NEPHROLOGY-

CiteScore

6.00

自引率

2.70%

发文量

审稿时长

27 weeks

期刊介绍： ''Kidney Diseases'' aims to provide a platform for Asian and Western research to further and support communication and exchange of knowledge. Review articles cover the most recent clinical and basic science relevant to the entire field of nephrological disorders, including glomerular diseases, acute and chronic kidney injury, tubulo-interstitial disease, hypertension and metabolism-related disorders, end-stage renal disease, and genetic kidney disease. Special articles are prepared by two authors, one from East and one from West, which compare genetics, epidemiology, diagnosis methods, and treatment options of a disease.