Goldenberg Ilan, Moss Arthur J, McNitt Scott, Zareba Wojciech, Andrews Mark L, Hall W Jackson, Greenberg Henry, Case Robert B
Cardiology Unit, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA.
Am J Cardiol. 2006 Aug 15;98(4):485-90. doi: 10.1016/j.amjcard.2006.03.025. Epub 2006 Jun 19.
Implanted cardioverter defibrillator therapy has been shown to be associated with a significant reduction in the risk of sudden cardiac death (SCD) in patients with ischemic left ventricular dysfunction. However, data on the relation between renal function and SCD in this population are limited, and the effect of renal dysfunction on the implanted cardioverter defibrillator benefit has not been determined. We performed a retrospective analysis of the outcome associated with renal dysfunction, as determined by the estimated glomerular filtration rate (eGFR), in patients enrolled in the Multicenter Automatic Defibrillator Implantation Trial-II. Multivariate analysis in conventionally treated patients showed that for each 10-U reduction in eGFR, the risk of all-cause mortality and SCD increased by 16% (p = 0.005) and 17% (p = 0.03), respectively. Defibrillator therapy was associated with a survival benefit in each eGFR category of > or = 35 ml/min/1.73 m2 (overall risk reduction for all-cause mortality 32%, p = 0.01 and for SCD 66%, p < 0.001). However, no implanted cardioverter defibrillator benefit was shown among patients with an eGFR < 35 ml/min/1.73 m2 (all-cause mortality hazard ratio 1.09, p = 0.84; SCD hazard ratio 0.95, p = 0.95). In conclusion, in patients with high-risk cardiac disease enrolled in the Multicenter Automatic Defibrillator Implantation Trial-II, a significant increase was found in the risk of SCD with declining renal function. Defibrillator therapy was associated with a significant survival benefit among the study patients with mild to moderate or no renal disease, but no benefit was shown among patients with more advanced renal dysfunction.
植入式心脏复律除颤器治疗已被证明可显著降低缺血性左心室功能不全患者的心源性猝死（SCD）风险。然而，该人群中肾功能与SCD之间关系的数据有限，且肾功能不全对植入式心脏复律除颤器获益的影响尚未确定。我们对多中心自动除颤器植入试验II中登记的患者进行了回顾性分析，根据估计肾小球滤过率（eGFR）确定肾功能不全与预后的关系。对接受常规治疗的患者进行多变量分析显示，eGFR每降低10个单位，全因死亡率和SCD风险分别增加16%（p = 0.005）和17%（p = 0.03）。在每个eGFR类别≥35 ml/min/1.73 m2的患者中，除颤器治疗均与生存获益相关（全因死亡率总体风险降低32%，p = 0.01；SCD风险降低66%，p < 0.001）。然而，在eGFR < 35 ml/min/1.73 m2的患者中未显示植入式心脏复律除颤器的获益（全因死亡率风险比1.09，p = 0.84；SCD风险比0.95，p = 0.95）。总之，在多中心自动除颤器植入试验II登记的高危心脏病患者中，发现肾功能下降时SCD风险显著增加。除颤器治疗在轻度至中度或无肾病的研究患者中与显著的生存获益相关，但在肾功能不全更严重的患者中未显示获益。
