Impaired renal function in patients with ischemic and nonischemic chronic heart failure: Association with neurohormonal activation and survival
Impaired renal function in patients with ischemic and nonischemic chronic heart failure: Association with neurohormonal activation and survival
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DOI：
10.1016/j.ahj.2004.02.007
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发表时间：
2004-07-01
影响因子：
4.8
通讯作者：
van Veldhuisen, DJ
中科院分区：
文献类型：
--
作者：
Smilde, TDJ;Hillege, HL;van Veldhuisen, DJ
背景肾功能不全是慢性心力衰竭(CHF)死亡率的重要预测因子。大多数CHF患者都有动脉粥样硬化性血管疾病，几位作者认为肾功能受损只是晚期动脉粥样硬化的一个标志。我们比较了缺血性和非缺血性CHF患者的肾功能，并检验了与预后和神经激素激活程度的相关性。方法在一项大型生存研究中(1906例患者)，将确诊的冠心病患者(n=995)与特发性扩张型心肌病患者(n=429)进行比较。在一项较小的子研究中，对270名患者和37名患者(分别为冠心病和IDC)进行了血浆神经激素测定。所有患者均有晚期CHF(纽约心脏协会功能III-IV级)。基线时，患者的平均年龄为10岁，平均左心室射血分数为0.26+/-0.08。用Cockcroft-Gault方程(GFRC)计算基线肾小球滤过率。结果多因素分析显示GFRC是两组患者死亡率的有力预测因子。IDC患者的相对危险度为3.04(P<0.01，最低四分位数小于或等于53毫升/分钟)，冠心病患者的相对危险度为1.81(P=0.01，最低四分位数小于或等于42毫升/分钟)。两组患者的血浆神经激素水平与GFRC呈正相关。结论GFRC与两组患者的生存和血浆神经激素水平有关。在IDC患者中，这种关联似乎至少与CAD患者一样强烈。
Background Renal dysfunction is a strong predictor of mortality in chronic heart failure (CHF). Most patients with CHF have atherosclerotic vascular disease, and several authors have suggested that impaired renal function is only a marker of advanced atherosclerosis. We compared renal function in patients with ischemic and nonischemic CHF and examined associations with prognosis and extent of neurohormonal activation.Methods In a large survival study (1906 patients), patients with documented coronary artery disease (CAD, n = 995), were compared with patients with idiopathic dilated cardiomyopathy (IDC, n = 429). In a smaller substudy, plasma neurohormones were determined in 270 patients and 37 patients (CAD and IDC, respectively). All patients had advanced CHF (New York Heart Association functional class III-IV). At baseline, the mean patient age was 64 10 years, and the mean left ventricular ejection fraction was 0.26 +/- 0.08. The baseline glomerular filtration rate was calculated with the Cockcroft-Gault equation (GFRc).Results GFRc was a strong predictor for mortality in both groups on multivariate analysis. The relative risk was 3.04 for patients with IDC (P less than or equal to.01, for the lowest quartile less than or equal to53 mL/min), and the relative risk for patients with CAD was 1.81 (P = .01 for the lowest quartile less than or equal to42 mL/min). Plasma neurohormones showed a relation with GFRc in both groups.Conclusions GFRc is related to survival and plasma neurohormones in both patient groups. In patients with IDC, this association appears to be at least as strong as in patients with CAD.