Yang S W, Liu Z M, Mi J R, Liu S Y, Ding L G, Chen K P, Hua W, Zhang S
State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2017 Mar 24;45(3):204-208. doi: 10.3760/cma.j.issn.0253-3758.2017.03.007.
To assess the relationship between serum albumin level and clinical outcome in heart failure (HF) patients receiving cardiac resynchronization therapy (CRT). In this retrospective cohort study, 357 consecutive chronic heart failure patients receiving CRT between January 2010 and December 2015 were enrolled and divided into two groups based on pre-CRT serum albumin (albumin≥40 g/L, =244; albumin<40 g/L, =113). Clinical outcomes were defined as all-cause mortality (including heart transplantation) and rehospitalization due to worsening HF.Baseline characteristics were compared and all-cause mortality (including heart transplantation) and rehospitalization due to worsening heart failure (HF) were analyzed using Kaplan-Meier curves.Prognostic value of albumin level was evaluated in Cox proportional-hazards regression models. Over a median follow-up time of 21 months, 45 patients (12.6%) died, 4 patients (1.1%) underwent heart transplantation and 100 patients (28.0%) were rehospitalized due to worsening HF. HF patients with pre-CRT albumin<40 g/L were related with worse NYHA function class, lower HDL-C level and ACEI/ARB use compared to HF patients with pre-CRT albumin≥40 g/L. Kaplan-Meier analyses evidenced lower survival rate in HF patients (log-rank test: =0.000 4, χ(2)=12.60) and higher rehospitalization rate due to worsening HF (log-rank test: =0.009, χ(2)=6.82) in HF patients with pre-CRT albumin<40 g/L.Multivariate Cox analyses indicated that serum pre-CRT albumin <40 g/L was an independent risk factor for all-cause mortality (=2.019, 95% 1.125-3.622, =0.018) and HF rehospitalization (=1.517, 95% 1.014-2.270, =0.043). Pre-CRT serum albumin level is associated with the severity of heart failure in CRT recipients.Patients with lower pre-CRT albumin level face increased risk of all-cause mortality and HF rehospitalization in chronic heart failure patients receiving cardiac resynchronization.
评估接受心脏再同步治疗（CRT）的心力衰竭（HF）患者血清白蛋白水平与临床结局之间的关系。在这项回顾性队列研究中，纳入了2010年1月至2015年12月期间连续接受CRT的357例慢性心力衰竭患者，并根据CRT前血清白蛋白水平将其分为两组（白蛋白≥40 g/L，n = 244；白蛋白<40 g/L，n = 113）。临床结局定义为全因死亡率（包括心脏移植）和因HF恶化导致的再次住院。比较基线特征，并使用Kaplan-Meier曲线分析全因死亡率（包括心脏移植）和因心力衰竭（HF）恶化导致的再次住院情况。在Cox比例风险回归模型中评估白蛋白水平的预后价值。在中位随访时间21个月期间，45例患者（12.6%）死亡，4例患者（1.1%）接受心脏移植，100例患者（28.0%）因HF恶化再次住院。与CRT前白蛋白≥40 g/L的HF患者相比，CRT前白蛋白<40 g/L的HF患者NYHA功能分级更差、HDL-C水平更低且ACEI/ARB使用更少。Kaplan-Meier分析表明，CRT前白蛋白<40 g/L的HF患者生存率较低（对数秩检验：P = 0.000 4，χ² = 12.60），因HF恶化导致的再次住院率较高（对数秩检验：P = 0.009，χ² = 6.82）。多变量Cox分析表明，CRT前血清白蛋白<40 g/L是全因死亡率（HR = 2.019，95%CI 1.125 - 3.622，P = 0.018）和HF再次住院（HR = 1.517，95%CI 1.014 - 2.270，P = 0.043）的独立危险因素。CRT前血清白蛋白水平与接受CRT患者的心力衰竭严重程度相关。CRT前白蛋白水平较低的患者在接受心脏再同步治疗的慢性心力衰竭患者中面临全因死亡率和HF再次住院风险增加。
