Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium; University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands.
Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium; Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.
J Card Fail. 2019 Oct;25(10):803-811. doi: 10.1016/j.cardfail.2019.07.005. Epub 2019 Jul 16.
Limited data are available concerning the effect of severe chronic kidney disease (CKD) on the response to cardiac resynchronization therapy (CRT) because these patients are commonly excluded from trials. Therefore, we aimed to assess the effect of CRT on renal function, reverse remodeling and outcome across all stages of CKD in a large patient population of recipients of CRT.
We retrospectively evaluated 798 consecutive patients with heart failure who were undergoing CRT implantation between October 2008 and September 2016. Renal function data were available at baseline and at 6 months following CRT. Remodeling based on left ventricular end diastolic volume/left ventricular ejection fraction (LVESV/LVEF) and clinical outcome was assessed using a combined endpoint of all-cause mortality and hospitalization because of heart failure.
Median baseline estimated glomerular filtration rate was 62.8 (43.6-77.8) mL/min/1.73 m. Of the patients, 33.6% were in CKD stage 3, 11.0% in stage 4 and 1.1% in stage 5. LVEF and LVESV improved across all CKD stages; however, patients with CKD stages 1 and 2 exhibited a greater degree of improvement in LVEF (median 15% vs 10%, P < 0.001) and LVESV (median -37.2% vs -29.9%, P < 0.001) compared to patients with CKD stages 3-5. Despite a greater degree of reverse remodeling in CKD stages 1 and 2, the most accurate cut-off of remodeling predicting good clinical outcome was lower for patients with CKD stage 3-5, respectively: 5.5% vs 9.5% (LVEF) and -6.67% vs -12.41% (LVESV).
CRT results in reverse remodeling across all stages of CKD, although to a lesser extent in patients with renal dysfunction (CKD stage 3-5). However, patients with CKD derive benefit on outcome at a lesser degree of remodeling.
由于严重慢性肾脏病（CKD）患者通常被排除在临床试验之外，因此关于其对心脏再同步治疗（CRT）反应的影响的数据有限。因此，我们旨在评估在接受 CRT 的大患者人群中，CKD 的所有阶段对肾功能、逆重构和结局的影响。
我们回顾性评估了 2008 年 10 月至 2016 年 9 月期间接受 CRT 植入的 798 例心力衰竭连续患者。在 CRT 后 6 个月时获得了肾功能数据。基于左心室舒张末期容积/左心室射血分数（LVESV/LVEF）的重构和临床结局使用全因死亡率和因心力衰竭住院的联合终点进行评估。
中位基线估计肾小球滤过率为 62.8（43.6-77.8）mL/min/1.73 m。患者中，33.6%处于 CKD 3 期，11.0%处于 4 期，1.1%处于 5 期。所有 CKD 阶段的 LVEF 和 LVESV 均得到改善；然而，CKD 1 期和 2 期患者的 LVEF（中位数 15%比 10%，P < 0.001）和 LVESV（中位数 -37.2%比 -29.9%，P < 0.001）改善程度更大与 CKD 3-5 期患者相比。尽管 CKD 1 期和 2 期的逆重构程度更大，但预测良好临床结局的重构最佳截断值在 CKD 3-5 期患者中更低，分别为：5.5%比 9.5%（LVEF）和 -6.67%比 -12.41%（LVESV）。
CRT 可在 CKD 的所有阶段实现逆重构，尽管在肾功能障碍（CKD 3-5 期）患者中程度较小。然而，CKD 患者的重构程度较低，对结局有获益。
