Impact of renal insufficiency on long-term clinical outcome in patients with heart failure treated by cardiac resynchronization therapy
Impact of renal insufficiency on long-term clinical outcome in patients with heart failure treated by cardiac resynchronization therapy
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DOI：
10.1016/j.jjcc.2012.06.001
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发表时间：
2012-09-01
影响因子：
2.5
通讯作者：
Umemura, Satoshi
中科院分区：
文献类型：
--
作者：
Hosoda, Junya;Ishikawa, Toshiyuki;Umemura, Satoshi
背景：肾功能不全被认为是心衰（HF）患者死亡率和不良结局的预测因子。然而，心脏再同步化治疗（CRT）对日本心衰肾功能不全患者的长期临床结果仍不确定。方法：对67例在我院连续行CRT的患者进行评价。根据肾小球滤过率（e-GFR）基准值50 ml/min的临界值将患者分为两组，该临界值由日本肾脏学会定义为患者应转诊肾病专家的时间。术后3-6个月复查超声心动图及肾功能。然后比较两组患者的长期临床结局，分析CRT对肾功能、超声心动图参数及心脏存活的影响。结果：在平均30.3个月的随访期间，晚期肾功能不全（e-GFR < 50 ml/min）患者的全因死亡率（log-rank p = 0.033）和合并HF住院的心脏死亡率（log-rank p = 0.017）明显高于e-GFR >= 50 ml/min的患者。多因素分析显示，晚期肾功能不全是心源性死亡合并心衰住院的独立预测因子（优势比= 3.01,p = 0.008）。基线晚期肾功能不全组的亚组分析显示，通过CRT保存肾功能的患者（e-GFR降低10%）。结论：本研究提示晚期肾功能不全对于预测CRT治疗的心衰患者临床预后恶化非常有用。通过CRT保存肾功能，即使是晚期肾功能不全的心衰患者，也能通过预防心脏不良事件而提高心脏存活率。(C) 2012年日本心脏病学会。Elsevier Ltd.出版。版权所有。
Background: Renal insufficiency is recognized as a predictor of mortality and adverse outcome in heart failure (HF) patients. However, the long-term clinical outcome of cardiac resynchronization therapy (CRT) in Japanese HF patients with renal insufficiency remains uncertain.Methods: We evaluated 67 consecutive patients who underwent CRT at our hospital. The patients were divided into two groups according to a baseline estimated glomerular filtration rate (e-GFR) cut-off value of 50 ml/min, which is defined as the time at which patients should be referred to a nephrologist, by the Japanese Society of Nephrology. Follow-up echocardiographic findings and renal function were examined at 3-6 months after CRT. Then, we compared long-term clinical outcomes between the two groups, and analyzed the effect of CRT on renal function, echocardiographic parameters and cardiac survival.Results: During a mean follow-up period of 30.3 months, patients with advanced renal insufficiency (e-GFR < 50 ml/min) had significant higher all-cause mortality (log-rank p = 0.033) and higher cardiac mortality combined with HF hospitalization (log-rank p = 0.017) than patients with e-GFR >= 50 ml/min. Multivariate analysis revealed that advanced renal insufficiency was an independent predictor of cardiac mortality combined with HF hospitalization (odds ratio = 3.01, p = 0.008). Subgroup analysis in the baseline advanced renal insufficiency group revealed that patients with preserved renal function by CRT (= 10% reduction in e-GFR).Conclusions: The present study suggests that advanced renal insufficiency is quite useful for the prediction of worsening clinical outcomes in HF patients treated by CRT. Preservation of renal function by CRT brings about better cardiac survival through prevention of adverse cardiac events, even in HF patients with advanced renal insufficiency. (C) 2012 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.