Serial changes in renal function as a prognostic indicator in advanced heart failure patients with left ventricular assist system.
Serial changes in renal function as a prognostic indicator in advanced heart failure patients with left ventricular assist system.
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DOI：
10.1016/j.athoracsur.2011.11.058
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发表时间：
2012-03
期刊：
影响因子：
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通讯作者：
Y. Iwashima;M. Yanase;T. Horio;O. Seguchi;Y. Murata;T. Fujita;K. Toda;Y. Kawano;T. Nakatani
中科院分区：
文献类型：
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作者：
Y. Iwashima;M. Yanase;T. Horio;O. Seguchi;Y. Murata;T. Fujita;K. Toda;Y. Kawano;T. Nakatani
背景：左心室辅助系统（LVAS）植入是晚期心力衰竭患者的一种成熟治疗方法。我们研究了LVAS植入后肾功能系列变化的临床意义。方法本研究纳入110例接受搏动性LVAS植入作为移植桥梁的患者，患者在植入后存活2周以上。在植入前1天（基线）和植入后2周进行人口统计学和血液学数据收集。所有患者监测2年或直至死亡。结果种植后2年死亡率为31.8%。多因素Cox回归分析显示，基线估计肾小球滤过率（eGFR）是死亡的独立预测因子（风险比为0.90，每增加10 mL/min， p < 0.05）。eGFR在LVAS植入后2周显著升高（70.5±37.8 ~ 121.0±78.8 mL/min, p < 0.01）。Kaplan-Meier曲线和log-rank检验显示，植入后2周eGFR变化的帧内值组（ΔeGFR; p = 0.03）和植入后2周eGFR变化最小的组（2w-eGFR; p < 0.01）的无事件生存率明显较低。多因素Cox回归分析显示，ΔeGFR（风险比为0.89，每增加10 mL/min）和2w-eGFR（风险比为0.92，每增加10 mL/min）是死亡的独立预测因子（p < 0.01）。结论肾功能受损，尤其是eGFR对LVAS植入的不良反应，可能与较差的预后密切相关。
BACKGROUNDLeft ventricular assist system (LVAS) implantation is an established treatment for patients with advanced heart failure. We investigated the clinical implication of serial changes in renal function after LVAS implantation.METHODSThis study included 110 patients who underwent pulsatile LVAS implantation intended as a bridge to transplantation and were alive more than 2 weeks after implantation. Data collection of demographic and hematologic values was performed 1 day before (baseline) and 2 weeks after implantation. All patients were monitored for 2 years or until death.RESULTSThe 2-year postimplantation mortality rate was 31.8%. Multivariate Cox regression analysis showed the baseline estimated glomerular filtration rate (eGFR) was an independent predictor of death (hazard ratio, 0.90 for each 10 mL/min increase, p < 0.05). The eGFR significantly increased at 2 weeks after LVAS implantation (70.5 ± 37.8 to 121.0 ± 78.8 mL/min, p < 0.01). Kaplan-Meier curves with log-rank tests showed significantly poorer event-free survival rates in the group with an inframedian value of change in eGFR at 2 weeks after implantation (ΔeGFR; p = 0.03) as well as in the group with the lowest tertile of eGFR at 2 weeks after implantation (2w-eGFR; p < 0.01). Multivariate Cox regression analysis showed that ΔeGFR (hazard ratio, 0.89 for each 10 mL/min increase) and 2w-eGFR (hazard ratio, 0.92 for each 10 mL/min increase) were independent predictors of death (p < 0.01, respectively).CONCLUSIONSImpaired renal function, and in particular, a poor response of eGFR to LVAS implantation, may have a strong association with worse outcome.