血清钾与射血分数保留的心力衰竭患者心血管事件的关系。
Serum Potassium and Cardiovascular Events in Heart Failure With Preserved Left Ventricular Ejection Fraction Patients.
机构信息
Department of Cardiovascular Medicine, Faculty of Life Sciences, Kumamoto University Graduate School of Medical Science, Kumamoto, Japan.
出版信息
Am J Hypertens. 2018 Sep 11;31(10):1098-1105. doi: 10.1093/ajh/hpy101.
BACKGROUND
Although serum potassium (sK) levels are closely associated with the prognosis of chronic heart failure patients, the clinical significance of sK levels in cardiovascular outcomes of heart failure with preserved ejection fraction (HFpEF) patients is not fully understood.
METHODS
This study was a retrospective, single-center, observational study. We enrolled 506 consecutive HFpEF patients admitted to Kumamoto University Hospital and divided them into four groups according to the quartiles of the sK levels at discharge (Q1: sK < 4.1 mEq/l, Q2: 4.1 ≤ sK < 4.4 mEq/l, Q3: 4.4 ≤ sK < 4.7 mEq/l, and Q4: sK ≥ 4.7 mEq/l).
RESULTS
No significant differences were observed in the use of all drugs (loop diuretics, mineralocorticoid receptor antagonists, renin-angiotensin-aldosterone system inhibitors, calcium channel blockers, β-blockers, and statins) among the four groups. Hemoglobin, the estimated glomerular filtration rate, and pulse wave velocity levels were lower, and the serum sodium levels were higher in the Q4 group compared with those in the Q2 group. Kaplan-Meier analysis revealed significantly higher probabilities of both cardiovascular and HF-related events in the Q1, Q3, and Q4 groups than those in the Q2 group. Multivariate Cox proportional hazard analysis revealed that the Q1, Q3, and Q4 groups had significantly and independently higher probabilities of cardiovascular events compared with those in the Q2 group, indicating a J-shaped association between sK levels and cardiovascular events.
CONCLUSIONS
sK levels at discharge could provide important prognostic information in regard to HFpEF. Further evaluation in a larger number of patients might be needed.
CLINICAL TRIALS REGISTRATION
UMIN-CTR (http://www.umin.ac.jp/ctr/).
IDENTIFIER
UMIN000029600.
PUBLIC ACCESS INFORMATION
Opt-out materials are available at the website: http://www.kumadai-junnai.com/home/wp-content/uploads/houkatsu.pdf.
背景
血清钾（sK）水平与慢性心力衰竭患者的预后密切相关，但 sK 水平对射血分数保留的心力衰竭（HFpEF）患者心血管结局的临床意义尚未完全阐明。
方法
这是一项回顾性、单中心、观察性研究。我们纳入了 506 例连续入住熊本大学医院的 HFpEF 患者，并根据出院时 sK 水平的四分位（Q1：sK<4.1mEq/l，Q2：4.1≤sK<4.4mEq/l，Q3：4.4≤sK<4.7mEq/l，Q4：sK≥4.7mEq/l）将其分为四组。
结果
四组患者的所有药物（袢利尿剂、盐皮质激素受体拮抗剂、肾素-血管紧张素-醛固酮系统抑制剂、钙通道阻滞剂、β受体阻滞剂和他汀类药物）使用率无显著差异。与 Q2 组相比，Q4 组的血红蛋白、估算肾小球滤过率和脉搏波速度水平较低，血清钠水平较高。Kaplan-Meier 分析显示，Q1、Q3 和 Q4 组的心血管和 HF 相关事件的发生概率均显著高于 Q2 组。多变量 Cox 比例风险分析显示，与 Q2 组相比，Q1、Q3 和 Q4 组的心血管事件发生概率显著更高，表明 sK 水平与心血管事件之间呈 J 型关系。
结论
出院时的 sK 水平可提供 HFpEF 患者重要的预后信息。可能需要在更多患者中进行进一步评估。
临床试验注册
UMIN-CTR（http://www.umin.ac.jp/ctr/）。
标识符
UMIN000029600。
公共获取信息
可在网站上获取免责材料：http://www.kumadai-junnai.com/home/wp-content/uploads/houkatsu.pdf。
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