左心室射血分数降低的慢性心力衰竭患者的肾功能与运动峰值耗氧量

Renal function and peak exercise oxygen consumption in chronic heart failure with reduced left ventricular ejection fraction.

作者信息

Scrutinio Domenico, Agostoni Piergiuseppe, Gesualdo Loreto, Corrà Ugo, Mezzani Alessandro, Piepoli Massimo, Di Lenarda Andrea, Iorio Annamaria, Passino Claudio, Magrì Damiano, Masarone Daniele, Battaia Elisa, Girola Davide, Re Federica, Cattadori Gaia, Parati Gianfranco, Sinagra Gianfranco, Villani Giovanni Quinto, Limongelli Giuseppe, Pacileo Giuseppe, Guazzi Marco, Metra Marco, Frigerio Maria, Cicoira Mariantonietta, Minà Chiara, Malfatto Gabriella, Caravita Sergio, Bussotti Maurizio, Salvioni Elisabetta, Veglia Fabrizio, Correale Michele, Scardovi Angela B, Emdin Michele, Giannuzzi Pantaleo, Gargiulo Paola, Giovannardi Marta, Perrone-Filardi Pasquale, Raimondo Rosa, Ricci Roberto, Paolillo Stefania, Farina Stefania, Belardinelli Romualdo, Passantino Andrea, La Gioia Rocco

机构信息

Division of Cardiology, "S. Maugeri" Foundation, IRCCS, Institute of Cassano Murge.

出版信息

Circ J. 2015;79(3):583-91. doi: 10.1253/circj.CJ-14-0806. Epub 2015 Jan 26.

DOI:10.1253/circj.CJ-14-0806

PMID:25746543

Abstract

BACKGROUND

Chronic kidney disease is associated with sympathetic activation and muscle abnormalities, which may contribute to decreased exercise capacity. We investigated the correlation of renal function with peak exercise oxygen consumption (V̇O2) in heart failure (HF) patients. METHODS AND RESULTS: We recruited 2,938 systolic HF patients who underwent clinical, laboratory, echocardiographic and cardiopulmonary exercise testing. The patients were stratified according to estimated glomerular filtration rate (eGFR). Mean follow-up was 3.7 years. The primary outcome was a composite of cardiovascular death and urgent heart transplantation at 3 years. On multivariable regression, eGFR was predictor of peakV̇O2(P<0.0001). Other predictors were age, sex, body mass index, HF etiology, NYHA class, atrial fibrillation, resting heart rate, B-type natriuretic peptide, hemoglobin, and treatment. After adjusting for significant covariates, the hazard ratio for primary outcome associated with peakV̇O2<12 ml·kg(-1)·min(-1)was 1.75 (95% confidence interval (CI): 1.06-2.91; P=0.0292) in patients with eGFR ≥60, 1.77 (0.87-3.61; P=0.1141) in those with eGFR of 45-59, and 2.72 (1.01-7.37; P=0.0489) in those with eGFR <45 ml·min(-1)·1.73 m(-2). The area under the receiver-operating characteristic curve for peakV̇O2<12 ml·kg(-1)·min(-1)was 0.63 (95% CI: 0.54-0.71), 0.67 (0.56-0.78), and 0.57 (0.47-0.69), respectively. Testing for interaction was not significant.

CONCLUSIONS

Renal dysfunction is correlated with peakV̇O2. A peakV̇O2cutoff of 12 ml·kg(-1)·min(-1)offers limited prognostic information in HF patients with more severely impaired renal function.

摘要

背景

慢性肾脏病与交感神经激活及肌肉异常相关，这可能导致运动能力下降。我们研究了心力衰竭（HF）患者肾功能与运动峰值耗氧量（V̇O2）之间的相关性。

方法与结果

我们招募了2938例收缩性HF患者，这些患者接受了临床、实验室、超声心动图和心肺运动测试。根据估计的肾小球滤过率（eGFR）对患者进行分层。平均随访时间为3.7年。主要结局是3年时心血管死亡和紧急心脏移植的复合结局。在多变量回归分析中，eGFR是峰值V̇O2的预测因素（P<0.0001）。其他预测因素包括年龄､性别､体重指数､HF病因､纽约心脏协会（NYHA）心功能分级､心房颤动､静息心率､B型利钠肽､血红蛋白和治疗情况。在对显著的协变量进行校正后，eGFR≥60的患者中，峰值V̇O2<12 ml·kg(-1)·min(-1)与主要结局相关的风险比为1.75（95%置信区间（CI）：1.06-2.91；P=0.0292），eGFR为45-59的患者中为1.77（0.87-3.61；P=0.1141），eGFR<45 ml·min(-1)·1.73 m(-2)的患者中为2.72（1.01-7.37；P=0.0489）。峰值V̇O2<12 ml·kg(-1)·min(-1)的受试者工作特征曲线下面积分别为0.63（95%CI：0.54-0.71）､0.67（0.56-0.78）和0.57（0.47-0.69）。交互作用检验无显著性。