The Association of Ejection Fraction With Hospital-Associated Cardiac Arrest and Heart Failure Hospitalization Differs According to Baseline Estimated GFR.
The Association of Ejection Fraction With Hospital-Associated Cardiac Arrest and Heart Failure Hospitalization Differs According to Baseline Estimated GFR.
复制标题
射血分数与医院相关的心脏骤停和心力衰竭住院的关联根据基线估计 GFR 的不同而不同。
DOI：
10.1016/j.ekir.2023.08.030
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发表时间：
2023-11
影响因子：
6
通讯作者：
Causland, Finnian R. Mc
中科院分区：
文献类型：
--
作者：
Ravi, Katherine Scovner;Mavrakanas, Thomas A.;Charytan, David M.;Causland, Finnian R. Mc
慢性肾脏疾病（CKD）和左心室功能障碍是心血管事件的危险因素。我们探讨左室射血分数（LVEF）与心脏骤停、心力衰竭住院和全因死亡率的关系是否在肾损害的不同阶段有所不同。我们在2004年至2014年期间对19032例患者进行了一项观察性队列研究，估计肾小球滤过率(eGFR)≤90 ml/min / 1.73 m2，无终末期肾病（ESKD）。Cox回归模型纳入eGFR和LVEF的相互作用项，对相关协变量进行拟合和调整。患者平均年龄67±14岁，男性占51%。平均eGFR为64±19 ml/min / 1.73 m2， LVEF为54±13%。在中位随访3.0年（0.7-6.0年）期间，有504例心脏骤停，4181例心力衰竭住院，6989例死亡。LVEF与心脏骤停和心力衰竭住院的相关性因持续eGFR而异（两种结果的p交互作用<0.01）。与eGFR最高的四分位数（LVEF每高5%的aHR 0.85, 95%可信区间[CI] 0.88-0.96）相比，LVEF与心脏骤停在最低四分位数的相关性减弱（调整后的危险比[aHR] 0.92； 95%可信区间[CI] 0.78-0.91）。在eGFR最低的四分位数中，LVEF与心力衰竭住院的相关性同样减弱。持续eGFR对LVEF对全因死亡率没有影响（p互作0.26）。在eGFR≤90 ml/min / 1.73 m2的非eskd患者中，LVEF与心脏骤停和心力衰竭住院的相关性在肾功能水平较低时减弱。需要进一步的研究来阐明LVEF之外的哪些因素驱动了这些观察结果。
Chronic kidney disease (CKD) and left ventricular (LV) dysfunction are risk factors for cardiovascular events. We explore whether the association of LV ejection fraction (LVEF) with cardiac arrest, heart failure hospitalization, and all-cause mortality differs across stages of kidney impairment. We performed an observational cohort study of 19,032 patients from 2004 to 2014 with estimated glomerular filtration rate (eGFR) ≤90 ml/min per 1.73 m2 and without end-stage kidney disease (ESKD). Cox regression models, incorporating an interaction term for eGFR and LVEF, were fit and adjusted for relevant covariates. Mean age of the patients was 67 ± 14 years, and 51% were male. The mean eGFR was 64 ± 19 ml/min per 1.73 m2 and LVEF was 54 ± 13%. Over a median follow-up of 3.0 (0.7–6.0) years there were 504 cardiac arrests, 4181 heart failure hospitalizations, and 6989 deaths. The association of LVEF with cardiac arrest and heart failure hospitalization differed according to continuous eGFR (P-interaction <0.01 for both outcomes). The association of LVEF with cardiac arrest in the lowest quartile was attenuated (adjusted hazard ration [aHR] per 5% higher LVEF 0.92; 95% confidence interval [CI] 0.88–0.96) compared to the highest eGFR quartile (aHR per 5% higher LVEF 0.85; 95% CI 0.78–0.91). The association of LVEF with heart failure hospitalization was similarly attenuated in the lowest eGFR quartile. There was no effect modification of LVEF by continuous eGFR for all-cause mortality (P-interaction 0.26). Among non-ESKD patients with eGFR ≤90 ml/min per 1.73 m2, the association of LVEF with cardiac arrest and heart failure hospitalization is attenuated at lower levels of kidney function. Further research is required to elucidate what factors beyond LVEF drive these observations.
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影响因子：
24
作者：
Weiner, Daniel E.;Tighiouart, Hocine;Sarnak, Mark J.
通讯作者：
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影响因子：
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作者：
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通讯作者：
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2.8
作者：
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通讯作者：
CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration)
影响因子：
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