Weidner Kathrin, Behnes Michael, Weiß Christel, Nienaber Christoph, Reiser Linda, Bollow Armin, Taton Gabriel, Reichelt Thomas, Ellguth Dominik, Engelke Niko, Rusnak Jonas, Schupp Tobias, Kim Seung-Hyun, Barth Christian, Hoppner Jorge, Akin Muharrem, Mashayekhi Kambis, Borggrefe Martin, Akin Ibrahim
First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Institute of Biomathematics and Medical Statistics, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, Heidelberg University, Mannheim, Germany.
Heart Vessels. 2019 Nov;34(11):1811-1822. doi: 10.1007/s00380-019-01415-z. Epub 2019 May 10.
The study sought to assess the impact of chronic kidney disease (CKD) on recurrences of ventricular tachyarrhythmias in implantable cardioverter defibrillator (ICD) recipients. Data regarding the outcome of patients with CKD in ICD recipients is limited. A large retrospective registry was used including consecutive ICD recipients surviving episodes of ventricular tachycardia (VT) or fibrillation (VF) from 2002 to 2016. CKD patients were compared to non-CKD patients. The primary endpoint was the first recurrence of ventricular tachyarrhythmias at 5 years. Secondary endpoints were ICD-related therapies, rehospitalization and all-cause mortality at 5 years. Kaplan-Meier, multivariable Cox regression and propensity score matching were applied. A total of 585 consecutive patients were included (non-CKD: 57%, CKD: 43%). CKD had higher rates of the primary endpoint of recurrent ventricular tachyarrhythmias compared to non-CKD patients (50% vs. 40%; log rank p = 0.008; HR = 1.398; 95% CI 1.087-1.770; p = 0.009), which was irrespective of a primary or secondary preventive ICD and mainly attributed to recurrent VF (11% vs. 5%; p = 0.007) and electrical storm (ES) (10% vs. 5%; p = 0.010). Accordingly, CKD patients had higher rates of the secondary endpoint of appropriate ICD therapies (41% vs. 30%; log rank p = 0.002; HR = 1.532; 95% CI 1.163-2.018; p = 0.002), mainly attributed to appropriate ICD shocks (19% vs. 11%; p = 0.005). After multivariable Cox regression CKD was associated with a 1.4-fold higher risk of appropriate device therapies (HR = 1.353; 95% CI 1.001-1.825; p = 0.049), but not with first recurrence of ventricular tachyarrhythmias (p = 0.177). Irrespective of propensity score matching, CKD was associated with increasing all-cause mortality at 5 years (p = 0.001). The presence of CKD is associated with increased rates of recurrent ventricular tachyarrhythmias, appropriate device therapies, mainly attributed to appropriate shock, and all-cause mortality in ICD recipients at 5 years.
该研究旨在评估慢性肾脏病（CKD）对植入式心律转复除颤器（ICD）植入者室性快速性心律失常复发的影响。关于ICD植入者中CKD患者结局的数据有限。我们使用了一个大型回顾性登记数据库，纳入了2002年至2016年间经历过室性心动过速（VT）或心室颤动（VF）发作且存活的连续ICD植入者。将CKD患者与非CKD患者进行比较。主要终点是5年时室性快速性心律失常的首次复发。次要终点是5年时与ICD相关的治疗、再次住院和全因死亡率。应用了Kaplan-Meier法、多变量Cox回归和倾向得分匹配法。共纳入585例连续患者（非CKD：57%，CKD：43%）。与非CKD患者相比，CKD患者室性快速性心律失常复发这一主要终点的发生率更高（50%对40%；对数秩检验p = 0.008；风险比[HR] = 1.398；95%置信区间[CI] 1.087 - 1.770；p = 0.009），这与原发性或继发性预防性ICD无关，主要归因于VF复发（11%对5%；p = 0.007）和电风暴（ES）（10%对5%；p = 0.010）。相应地，CKD患者适当ICD治疗这一次要终点的发生率更高（41%对30%；对数秩检验p = 0.002；HR = 1.532；95% CI 1.163 - 2.018；p = 0.002），主要归因于适当的ICD电击（19%对11%；p = 0.005）。多变量Cox回归分析后，CKD与适当设备治疗风险高1.4倍相关（HR = 1.353；95% CI 1.001 - 1.825；p = 0.049），但与室性快速性心律失常的首次复发无关（p = 0.177）。无论倾向得分匹配情况如何，CKD与5年时全因死亡率增加相关（p = 0.001）。CKD的存在与ICD植入者5年时室性快速性心律失常复发率增加、适当设备治疗（主要归因于适当电击）及全因死亡率增加相关。
