基线肾功能对接受心脏再同步治疗患者全因死亡率的影响：一项系统评价和荟萃分析。
Impact of baseline renal function on all-cause mortality in patients who underwent cardiac resynchronization therapy: A systematic review and meta-analysis.
作者信息
Bazoukis G, Letsas K P, Korantzopoulos P, Thomopoulos C, Vlachos K, Georgopoulos S, Karamichalakis N, Saplaouras A, Efremidis M, Sideris A
机构信息
Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Athens, Greece.
First Department of Cardiology, University of Ioannina, Medical School, Ioannina, Greece.
出版信息
J Arrhythm. 2017 Oct;33(5):417-423. doi: 10.1016/j.joa.2017.04.005. Epub 2017 May 1.
BACKGROUND
Cardiac resynchronization therapy (CRT) improves both morbidity and mortality in selected patients with heart failure and increased QRS duration. However, chronic kidney disease (CKD) may have an adverse effect on patient outcome. The aim of this systematic review was to analyze the existing data regarding the impact of baseline renal function on all-cause mortality in patients who underwent CRT.
METHODS
Medline database was searched systematically, and studies evaluating the effect of baseline renal function on all-cause mortality in patients who underwent CRT were retrieved. We performed three separate analyses according to the comparison groups included in each study. Data were analyzed using Review Manager software (RevMan version 5.3; Oxford, UK).
RESULTS
We included 16 relevant studies in our analysis. Specifically, 13 studies showed a statistically significant higher risk of all-cause mortality in patients with impaired baseline renal function who underwent CRT. The remaining three studies did not show a statistically significant result. The quantitative synthesis of five studies showed a 19% decrease in all-cause mortality per 10-unit increment in estimated glomerular filtration rate (eGFR) [HR: 0.81, 95% CI (0.73-0.90), <0.01, 86% ]. Additionally, we demonstrated that patients with an eGFR<60 mL/min/1.73 m had an all-cause mortality rate of 66% [HR: 1.66, 95% CI (1.37-2.02), <0.01, 0% I], which was higher than in those with an eGFR≥60 mL/min/1.73 m.
CONCLUSION
Baseline renal dysfunction has an adverse effect on-all cause mortality in patients who underwent CRT.
背景
心脏再同步治疗（CRT）可改善部分心力衰竭且QRS波时限延长患者的发病率和死亡率。然而，慢性肾脏病（CKD）可能对患者的预后产生不利影响。本系统评价的目的是分析关于基线肾功能对接受CRT治疗患者全因死亡率影响的现有数据。
方法
系统检索Medline数据库，检索评估基线肾功能对接受CRT治疗患者全因死亡率影响的研究。我们根据每项研究纳入的比较组进行了三项独立分析。使用Review Manager软件（RevMan 5.3版；英国牛津）分析数据。
结果
我们的分析纳入了16项相关研究。具体而言，13项研究显示，接受CRT治疗且基线肾功能受损的患者全因死亡风险在统计学上显著更高。其余三项研究未显示出统计学上的显著结果。五项研究的定量综合分析显示，估计肾小球滤过率（eGFR）每增加10个单位，全因死亡率降低19%[风险比（HR）：0.81，95%置信区间（CI）（0.73 - 0.90），P<0.01，I² = 86%]。此外，我们还证明，eGFR<60 mL/min/1.73 m²的患者全因死亡率为66%[HR：1.66，95%CI（1.37 - 2.02），P<0.01，I² = 0%]，高于eGFR≥60 mL/min/1.73 m²的患者。
结论
基线肾功能不全对接受CRT治疗的患者全因死亡率有不利影响。
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