Nakajima Yuri, Kawarada Osami, Higashimori Akihiro, Yokoi Yoshiaki, Zen Kan, Anzai Hitoshi, Doi Hideki, Hokimoto Seiji, Ito Shigenori, Kato Taku, Kume Teruyoshi, Shintani Yoshiaki, Tanimoto Shuzou, Tsubakimoto Yoshinori, Utsunomiya Makoto, Nishimura Kunihiro, Yasuda Satoshi
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan.
Heart Asia. 2017 Sep 14;9(2):e010934. doi: 10.1136/heartasia-2017-010934. eCollection 2017.
There have been limited data regarding the prediction of cardiac benefits after renal artery stenting for patients with atherosclerotic renal artery disease (ARAD). The aim of this multicentre retrospective study was to identify clinical or echocardiographic factors associated with improvements of cardiac symptoms after renal artery stenting.
We enrolled 58 patients with de novo ARAD undergoing successful renal artery stenting for heart failure, angina or both between January 2000 and August 2015 at 13 hospitals.
Improvement of cardiac symptoms was observed in 86.2% of patients during a mean follow-up of 6.0±2.7 months. Responders demonstrated significantly lower New York Heart Association functional class, higher estimated glomerular filtration rate, lower serum creatinine and lower interventricular septal wall thickness (IVS), lower left ventricular mass index, lower left atrial dimension and lower E-velocity than non-responders. Backward stepwise multivariate analysis identified IVS as an independent predictor of improvement of cardiac symptoms (OR 0.451, 95% CI 0.209 to 0.976; p=0.043). According to receiver operating characteristic curve analysis, an IVS cut-off of 11.9 mm provided the best predictive value, with sensitivity of 71.4%, specificity of 75.5% and accuracy of 73.5%. The positive predictive value was 74.5% and the negative predictive value was 72.5%.
This multicentre retrospective study shows that the echocardiographic index of IVS is an independent predictor for improvement of cardiac symptoms after renal artery stenting.
关于动脉粥样硬化性肾动脉疾病（ARAD）患者肾动脉支架置入术后心脏获益预测的数据有限。这项多中心回顾性研究的目的是确定与肾动脉支架置入术后心脏症状改善相关的临床或超声心动图因素。
我们纳入了2000年1月至2015年8月期间在13家医院因心力衰竭、心绞痛或两者而接受初次ARAD成功肾动脉支架置入术的58例患者。
在平均6.0±2.7个月的随访期间，86.2%的患者心脏症状得到改善。与无反应者相比，有反应者的纽约心脏协会功能分级显著更低，估计肾小球滤过率更高，血清肌酐更低，室间隔厚度（IVS）更低，左心室质量指数更低，左心房内径更低，E波速度更低。向后逐步多变量分析确定IVS是心脏症状改善的独立预测因子（比值比0.451，95%置信区间0.209至0.976；p=0.043）。根据受试者工作特征曲线分析，IVS截断值为11.9mm时预测价值最佳，敏感性为71.4%，特异性为75.5%，准确性为73.5%。阳性预测值为74.5%，阴性预测值为72.5%。
这项多中心回顾性研究表明，IVS的超声心动图指数是肾动脉支架置入术后心脏症状改善的独立预测因子。
