心力衰竭合并慢性肾脏病患者的心律失常和非心律失常性死亡风险。

Risk of arrhythmic and nonarrhythmic death in patients with heart failure and chronic kidney disease.

机构信息

Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA.

出版信息

Am Heart J. 2011 Jan;161(1):204-209.e1. doi: 10.1016/j.ahj.2010.09.020.

DOI:10.1016/j.ahj.2010.09.020

PMID:21167355

Abstract

BACKGROUND

optimal utilization of therapies effective at preventing arrhythmic death but not nonarrhythmic death, for example, the implantable cardioverter-defibrillator (ICD), is challenging in patients with concomitant heart failure (HF) and chronic kidney disease (CKD), given the association of both conditions with competing risks of death.

OBJECTIVES

we examined the risk of arrhythmic and nonarrhythmic mortality in patients with different severities of HF and CKD.

METHODS

using individual patient data from the SOLVD, we categorized HF by New York Heart Association class and CKD severity by estimated glomerular filtration rate. Cox models with HF and CKD stages as time-dependent covariates were used to calculate hazard ratios for arrhythmic and nonarrhythmic death adjusted for age, gender, and enalapril allocation.

RESULTS

among 6,378 patients without an ICD (age 60 ± 10, left ventricular ejection fraction 27 ± 6, male 86%), there were 421 arrhythmic and 1188 nonarrhythmic deaths over a median follow-up of 34 months. Worse HF or CKD stages were associated with increased risk of both arrhythmic and nonarrhythmic death. The increase in the risk of nonarrhythmic death in the worst HF stage was disproportionately higher than that of arrhythmic death, and this disproportionate effect was more exaggerated in the presence of more advanced CKD.

CONCLUSION

while advanced CKD and HF stages are associated with increased risk of arrhythmic and nonarrhythmic death, benefits of ICDs in patients with more advanced disease may be limited by the preponderance of nonarrhythmic death.

摘要

背景

对于同时患有心力衰竭（HF）和慢性肾脏病（CKD）的患者，有效预防心律失常性死亡但不能预防非心律失常性死亡的治疗方法（例如植入式心脏复律除颤器 [ICD]）的最佳利用具有挑战性，因为这两种情况都与死亡的竞争风险相关。

目的

我们研究了不同 HF 和 CKD 严重程度患者的心律失常和非心律失常死亡率风险。

方法

使用 SOLVD 中的个体患者数据，我们按纽约心脏协会（NYHA）分级和估计肾小球滤过率（eGFR）将 HF 分类。使用 Cox 模型，HF 和 CKD 阶段作为时间依赖性协变量，计算调整年龄、性别和依那普利分配后心律失常和非心律失常死亡的危险比。

结果

在 6378 名没有 ICD 的患者中（年龄 60±10 岁，左心室射血分数 27±6%，男性 86%），中位随访 34 个月期间，有 421 例心律失常性和 1188 例非心律失常性死亡。更严重的 HF 或 CKD 阶段与心律失常和非心律失常死亡的风险增加相关。HF 最严重阶段的非心律失常死亡风险增加不成比例地高于心律失常死亡风险，而在 CKD 更严重的情况下，这种不成比例的影响更为明显。