Bonato Fabiana Oliveira Bastos, Watanabe Renato, Lemos Marcelo Montebello, Cassiolato José Luiz, Wolf Myles, Canziani Maria Eugênia Fernandes
Department of Internal Medicine, Division of Nephrology, Federal University of São Paulo, São Paulo, Brazil.
Cardios Research Institute, São Paulo, Brazil.
Cardiorenal Med. 2016 Nov;7(1):66-73. doi: 10.1159/000449260. Epub 2016 Oct 28.
BACKGROUND/AIMS: Ventricular arrhythmia is associated with increased risk of cardiovascular events and death in the general population. Sudden death is a leading cause of death in end-stage renal disease. We aimed at evaluating the effects of ventricular arrhythmia on clinical outcomes in patients with earlier stages of chronic kidney disease (CKD).
In a prospective study of 109 nondialyzed CKD patients (estimated glomerular filtration rate 34.8 ± 16.1 ml/min/1.73 m, 57 ± 11.4 years, 61% male, 24% diabetics), we tested the hypothesis that the presence of subclinical complex ventricular arrhythmia, assessed by 24-hour electrocardiogram, is associated with increased risks of cardiovascular events, hospitalization, and death and with their composite outcome during 24 months of follow-up. Complex ventricular arrhythmia was defined as the presence of multifocal ventricular extrasystoles, paired ventricular extrasystoles, nonsustained ventricular tachycardia, or R wave over T wave.
We identified complex ventricular arrhythmia in 14% of participants at baseline. During follow-up, 11 cardiovascular events, 15 hospitalizations, and 4 deaths occurred. The presence of complex ventricular arrhythmia was associated with cardiovascular events (p < 0.001), hospitalization (p = 0.018), mortality (p < 0.001), and the composite outcome (p < 0.001). In multivariate Cox regression analysis, adjusting for demographic characteristics, complex ventricular arrhythmia was associated with increased risk of the composite outcome (HR 4.40; 95% CI 1.60-12.12; p = 0.004).
In this pilot study, the presence of asymptomatic complex ventricular arrhythmia was associated with poor clinical outcomes in nondialyzed CKD patients.
背景/目的：在普通人群中，室性心律失常与心血管事件和死亡风险增加相关。猝死是终末期肾病的主要死因。我们旨在评估室性心律失常对慢性肾脏病（CKD）早期患者临床结局的影响。
在一项对109例未透析的CKD患者（估计肾小球滤过率34.8±16.1 ml/min/1.73 m²，57±11.4岁，61%为男性，24%为糖尿病患者）的前瞻性研究中，我们检验了这样一个假设，即通过24小时心电图评估的亚临床复杂性室性心律失常的存在与心血管事件、住院和死亡风险增加以及24个月随访期间的综合结局相关。复杂性室性心律失常定义为存在多源性室性期前收缩、成对室性期前收缩、非持续性室性心动过速或T波上的R波。
在基线时，我们在14%的参与者中发现了复杂性室性心律失常。在随访期间，发生了11次心血管事件、15次住院和4例死亡。复杂性室性心律失常的存在与心血管事件（p<0.001）、住院（p = 0.018）、死亡率（p<0.001）和综合结局（p<0.001）相关。在多变量Cox回归分析中，调整人口统计学特征后，复杂性室性心律失常与综合结局风险增加相关（风险比4.40；95%置信区间1.60 - 12.12；p = 0.004）。
在这项初步研究中，无症状复杂性室性心律失常的存在与未透析CKD患者的不良临床结局相关。
