Division of Hypertension and Nephrology, Department of Medicine, National Cerebral and Cardiovascular Center, Suita City, Osaka, Japan.
Ann Thorac Surg. 2012 Mar;93(3):816-23. doi: 10.1016/j.athoracsur.2011.11.058.
Left ventricular assist system (LVAS) implantation is an established treatment for patients with advanced heart failure. We investigated the clinical implication of serial changes in renal function after LVAS implantation.
This study included 110 patients who underwent pulsatile LVAS implantation intended as a bridge to transplantation and were alive more than 2 weeks after implantation. Data collection of demographic and hematologic values was performed 1 day before (baseline) and 2 weeks after implantation. All patients were monitored for 2 years or until death.
The 2-year postimplantation mortality rate was 31.8%. Multivariate Cox regression analysis showed the baseline estimated glomerular filtration rate (eGFR) was an independent predictor of death (hazard ratio, 0.90 for each 10 mL/min increase, p<0.05). The eGFR significantly increased at 2 weeks after LVAS implantation (70.5±37.8 to 121.0±78.8 mL/min, p<0.01). Kaplan-Meier curves with log-rank tests showed significantly poorer event-free survival rates in the group with an inframedian value of change in eGFR at 2 weeks after implantation (ΔeGFR; p=0.03) as well as in the group with the lowest tertile of eGFR at 2 weeks after implantation (2w-eGFR; p<0.01). Multivariate Cox regression analysis showed that ΔeGFR (hazard ratio, 0.89 for each 10 mL/min increase) and 2w-eGFR (hazard ratio, 0.92 for each 10 mL/min increase) were independent predictors of death (p<0.01, respectively).
Impaired renal function, and in particular, a poor response of eGFR to LVAS implantation, may have a strong association with worse outcome.
左心室辅助系统（LVAS）的植入是治疗晚期心力衰竭患者的一种成熟治疗方法。我们研究了 LVAS 植入后肾功能的连续变化的临床意义。
这项研究纳入了 110 名接受搏动性 LVAS 植入的患者，这些患者植入的目的是作为移植的桥梁，并且在植入后 2 周以上仍存活。在植入前 1 天（基线）和植入后 2 周采集人口统计学和血液学数据。所有患者均接受了 2 年或直至死亡的监测。
植入后 2 年的死亡率为 31.8%。多变量 Cox 回归分析显示，基线估算肾小球滤过率（eGFR）是死亡的独立预测因素（风险比，每增加 10ml/min 增加 0.90，p<0.05）。LVAS 植入后 2 周时 eGFR 显著增加（70.5±37.8 至 121.0±78.8ml/min，p<0.01）。对数秩检验的 Kaplan-Meier 曲线显示，植入后 2 周时 eGFR 变化的中位数以下组（ΔeGFR；p=0.03）以及植入后 2 周时 eGFR 最低三分位组（2w-eGFR；p<0.01）的无事件生存率显著较差。多变量 Cox 回归分析显示，ΔeGFR（风险比，每增加 10ml/min 增加 0.89）和 2w-eGFR（风险比，每增加 10ml/min 增加 0.92）是死亡的独立预测因素（p<0.01，分别）。
肾功能受损，特别是 eGFR 对 LVAS 植入的反应不良，可能与预后较差密切相关。
