Yufu Kunio, Abe Ichitaro, Kondo Hidekazu, Saito Shotaro, Fukui Akira, Okada Norihiro, Akioka Hidefumi, Shinohara Tetsuji, Teshima Yasushi, Nakagawa Mikiko, Takahashi Naohiko
Department of Cardiology and Clinical Examination Faculty of Medicine Oita University Oita Japan.
J Arrhythm. 2020 Nov 10;37(1):173-181. doi: 10.1002/joa3.12447. eCollection 2021 Feb.
It is common to develop heart failure (HF) events even in respondents to cardiac resynchronization therapy (CRT) during a long-term observation period. We investigated the predictors for long-term outcome in responders in comparison with nonresponders in patients diagnosed with HF along with implanted CRT.
We enrolled 133 consecutive patients (mean age, 70 ± 10 years; 72 males) implanted with CRT from April 2010 to July 2019. Accurate follow-up information (mean follow-up period, 983 ± 801 days) was obtained from 66 responders and 53 nonresponders.
Kaplan-Meier event-free curves showed that major adverse cerebral and cardiovascular event (MACCE)-free ratio was significantly lower as the stage of renal function progresses (log rank, 19.5; < .0001). The baseline estimated glomerular filtration rate (e-GFR) before CRT was not significantly different between nonresponders and responders. The e-GFR after judgment of CRT response was lower in patients with MACCEs than those without. Cox proportional hazards regression analysis revealed that low baseline e-GFR before CRT and after judgment of CRT response was closely related with MACCEs in responders, but not in nonresponders. The survival rate in responders without MACCEs assessed using Kaplan-Meier analysis was significantly larger in the preserved e-GFR (baseline value before CRT, >44 mL/min/1.73 m) group than in the depressed group (log rank, 20.29; < .0001).
We demonstrate that the factors for MACCEs during long follow-up periods were distinctively different between responders and nonresponders. Patients with depressed e-GFRs are suggested to have poor prognosis even if they are responders to CRT.
即使在接受心脏再同步治疗（CRT）的患者中，在长期观察期内发生心力衰竭（HF）事件也很常见。我们调查了与未对CRT产生反应的患者相比，已对CRT产生反应的患者长期预后的预测因素，这些患者均被诊断为HF并植入了CRT。
我们纳入了2010年4月至2019年7月期间连续植入CRT的133例患者（平均年龄70±10岁；男性72例）。从66例有反应者和53例无反应者那里获得了准确的随访信息（平均随访期983±801天）。
Kaplan-Meier无事件曲线显示，随着肾功能分期的进展，无主要不良脑和心血管事件（MACCE）的比例显著降低（对数秩检验，19.5；P<0.0001）。无反应者和有反应者在CRT前的基线估计肾小球滤过率（e-GFR）无显著差异。发生MACCE的患者在判断CRT反应后的e-GFR低于未发生MACCE的患者。Cox比例风险回归分析显示，CRT前及判断CRT反应后的低基线e-GFR与有反应者发生MACCE密切相关，而与无反应者无关。使用Kaplan-Meier分析评估，e-GFR保留组（CRT前基线值>44 mL/min/1.73 m²）中有反应且无MACCE患者的生存率显著高于e-GFR降低组（对数秩检验，20.29；P<0.0001）。
我们证明，在长期随访期间，有反应者和无反应者发生MACCE的因素明显不同。即使是对CRT有反应的患者，e-GFR降低者的预后也较差。
