冠状动脉微血管功能障碍,左心室重塑和慢性功能障碍患者的临床结果
Navkaranbir S Bajaj1,2, Amitoj Singh1, Wunan Zhou1
1Cardiovascular Imaging Program, Departments of Radiology and Medicine; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology; and Divisions of Cardiovascular Medicine and Nephrology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (N.S.B., A.S., W.Z., A.G., K.F., C.B., H.J.H., P.B., E.A., S.D., C.F.B., J.H., H.S., V.T., M.S., S.D., R.B., R.C.D., S.D.S., M.F.D.C.).
Circulation
|November 30, 2019
概括
在没有明显冠状动脉疾病的患者中,冠状动脉微血管功能障碍,而不是功能,可以独立预测心脏问题. 这种功能障碍可能将病与心脏问题和心血管不良事件联系在一起.
科学领域:
- 心脏病学
- 肝脏病学
- 心血管成像
背景情况:
- 患有慢性病 (CKD) 的患者经常出现心脏功能障碍和心血管事件,即使没有阻塞性冠状动脉疾病.
- 关联CKD与心脏功能障碍和不良结果的潜在机制尚不清楚.
- 冠状动脉微血管功能障碍 (CMD) 被认为是功能障碍和心脏问题之间的联系.
研究的目的:
- 研究CKD,CMD,心脏功能障碍和心血管结果之间的关联.
- 在没有明显冠状动脉疾病的患者中,确定CMD是否介导CKD与心血管不良事件之间的联系.
主要方法:
- 在352名接受心脏应激正子发射断层扫描 (PET) 和心声扫描的患者中进行了长度研究.
- 通过估计的球过率 (eGFR) 评估功能.
- 通过PET测量冠状动脉流量储备 (CFR);通过心声学评估心脏力学 (透心和静心指数).
- 随访患者的综合结果是死亡,心肌梗塞或心力衰竭住院.
- 统计分析包括多变量模型和调解分析.
主要成果:
- 35% 的患者的EGFR < 60 mL·min-1·1. 73 m-2;中位数的CFR为1. 8.
- eGFR和CFR都与心脏机制和心血管事件相关 (P<0. 05).
- 在多变量模型中,CFR,但不是eGFR,与心脏机制和心血管事件独立相关.
- 电子回路率,心脏力学和心血管事件之间的关系部分由CFR介导.
结论:
- 冠状动脉微血管功能障碍,而不是单独的EGFR,与心脏机制异常和心血管事件风险增加有关.
- 在没有明显冠状动脉疾病的患者中,CMD可能是连接CKD与心脏功能障碍和心血管不良结果的关键媒介.
相关概念视频
01:24Chronic Kidney Disease II: Clinical Manifestations
495
Chronic Kidney Disease (CKD) progressively impairs multiple body systems due to the accumulation of uremic toxins, which disrupt cellular functions across various organs.Neurologic symptomsNeurologic symptoms often arise early in CKD, as uremic toxin buildup drives changes in cognitive and motor functions. Patients frequently experience fatigue, headache, confusion, difficulty concentrating, and, in severe cases, seizures. Peripheral neuropathy commonly manifests as burning sensations in the...
495
01:28Chronic Kidney Disease III: Interprofessional Care
300
Chronic kidney disease (CKD) requires collaborative and comprehensive management. CKD progresses through stages and can lead to end-stage kidney disease (ESKD) if untreated. Interprofessional collaboration and patient education are crucial, enabling patients to manage their health and improve their quality of life.Diagnostic approach for chronic kidney diseaseThe diagnosis of CKD primarily focuses on the glomerular filtration rate (GFR), which assesses kidney function by measuring how well...
300
01:25Chronic Kidney Disease I: Introduction
516
Chronic Kidney Disease (CKD) arises when the kidneys progressively lose their ability to function, ultimately leading to end-stage renal disease. At this advanced stage, the kidneys can no longer filter waste or maintain essential body functions, requiring renal replacement therapy (RRT) through dialysis or a kidney transplant for survival.Early-stage chronic kidney disease and detection challengesIn CKD's early stages, symptoms often remain absent because healthy nephrons compensate for...
516
01:18Chronic Kidney Disease IV: Nursing Management
257
Nursing management is essential for preventing complications, maintaining stability, and improving patients' quality of life in chronic kidney disease (CKD). By using a structured approach, nurses help slow CKD progression and support effective patient care.1. Comprehensive patient assessmentEffective management begins with nurses reviewing the patient’s medical history, and identifying key risk factors like diabetes, hypertension, and nephrotoxic drug use. Nurses assess signs of...
257
01:29Acute Kidney Injury II: Pathophysiology
798
Acute kidney injury (AKI) causes are categorized into three primary categories based on the location of the injury: prerenal, intrarenal (or intrinsic), and postrenal causes. This classification guides clinical management and illustrates how different pathways can impair kidney function.Etiology and Pathophysiology of Acute Kidney Injury1. Prerenal causesEtiology: Prerenal Acute Kidney Injury, the most common type, occurs when reduced blood flow to the kidneys decreases filtration capacity...
798
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
227
Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
227