Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Circ J. 2013;77(1):116-22. doi: 10.1253/circj.cj-12-0672. Epub 2012 Sep 28.
Various factors associated with worsening heart failure (HF) events have been investigated in HF subjects. The purpose of this study was to identify the predictive factor(s) for worsening HF events after cardiac resynchronization therapy (CRT) among baseline parameters, as well as baseline factors associated with responsiveness or non-responsiveness to CRT.
Seventy-seven HF patients with an indication for CRT were enrolled. Baseline parameters of blood chemistry, electrocardiogram, echocardiogram and cardiac catheterization before device implantation were measured, and subsequent clinical HF events after CRT were investigated. During the follow-up period (median 601 days), 22 of 77 (29%) recipients had HF events (unscheduled HF hospitalization: 16; use of left ventricular assist system: 1; heart transplantation: 1; cardiac death: 4). In the multivariate Cox proportional hazards model, low serum sodium concentration was associated with the occurrence of HF events after CRT (hazard ratio 0.82, 95% confidence interval 0.68-0.99, P=0.034). At baseline, serum sodium concentration negatively correlated with pulmonary capillary wedge pressure (r=-0.71, P<0.001) and with plasma arginine vasopressin level (r=-0.68, P=0.008).
Hyponatremia is an independent predictor for worsening HF events after CRT implantation, which may be partly explained by elevated level of plasma arginine vasopressin.
各种与心力衰竭（HF）恶化事件相关的因素已在 HF 患者中进行了研究。本研究的目的是确定心脏再同步治疗（CRT）后基线参数恶化 HF 事件的预测因素，以及与 CRT 反应性或无反应性相关的基线因素。
共纳入 77 例有 CRT 适应证的 HF 患者。在植入设备前测量血液化学、心电图、超声心动图和心导管检查的基线参数，并调查 CRT 后的后续临床 HF 事件。在随访期间（中位数 601 天），77 例受者中有 22 例（29%）发生 HF 事件（计划外 HF 住院：16 例；使用左心室辅助系统：1 例；心脏移植：1 例；心脏死亡：4 例）。在多变量 Cox 比例风险模型中，血清钠浓度低与 CRT 后 HF 事件的发生相关（风险比 0.82，95%置信区间 0.68-0.99，P=0.034）。基线时，血清钠浓度与肺毛细血管楔压（r=-0.71，P<0.001）和血浆血管加压素水平（r=-0.68，P=0.008）呈负相关。
低钠血症是 CRT 植入后 HF 恶化事件的独立预测因素，这可能部分解释为血浆血管加压素水平升高。
