Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan.
Department of Medicine Taipei Veterans General Hospital Yuanshan and Suao Branch Yilan Taiwan.
J Am Heart Assoc. 2021 Dec 21;10(24):e021585. doi: 10.1161/JAHA.121.021585. Epub 2021 Dec 10.
Background Glomerular hyperfiltration (GHF) is paradoxically associated with increased cardiovascular events in healthy individuals, but the pathogenesis remains unclear. We aim to investigate whether GHF is associated with mortality and whether decreased heart rate variability (HRV) is associated with GHF. Methods and Results We retrospectively analyzed 1615 participants (aged 66.1±17.3 years, 61.9% men) without prior cardiovascular events. The glomerular filtration rate was estimated using the Chronic Kidney Disease Epidemiology Collaboration equation. GHF was defined as glomerular filtration rate >the 95th percentile after stratification for age and sex, whereas normal filtration was defined as the 25th to 75th percentiles. HRV indexes, including time domain, frequency domain, and sample entropy, were measured using 24-hour ambulatory electrocardiography. Clinical outcomes were defined as all-cause mortality at 2 years. During a mean follow-up of 16.5±8.2 months, there were 117 deaths (7.2%). GHF was associated with a higher risk of death (hazard ratio and 95% CIs, 1.97 [1.15-3.37]). Reduced HRV indexes, including time domain, frequency domain, and sample entropy (odds ratio and 95% CIs, 0.79 [0.70-0.89]) were all independently associated with the presence of GHF after accounting for age, sex, mean heart rate, morbidities, and medications. In subgroup analysis, reduced HRV was more predictive of GHF in the young than the elderly. Mediation analysis revealed a significant mediation effect between HRV and GHF in addition to their respective detrimental effects on survival. Conclusions Reduced HRV was independently associated with the presence of GHF. Autonomic dysfunction may be involved in the pathogenesis of adverse outcomes of GHF in individuals without prior cardiovascular events.
肾小球高滤过(GHF)与健康个体中心血管事件的增加呈矛盾关系,但发病机制尚不清楚。我们旨在研究 GHF 是否与死亡率相关,以及心率变异性(HRV)降低是否与 GHF 相关。
我们回顾性分析了 1615 名无先前心血管事件的参与者(年龄 66.1±17.3 岁,61.9%为男性)。使用慢性肾脏病流行病学合作方程估计肾小球滤过率。GHF 定义为按年龄和性别分层后肾小球滤过率>第 95 百分位数,而正常滤过定义为第 25 至 75 百分位数。使用 24 小时动态心电图测量 HRV 指数,包括时域、频域和样本熵。临床结局定义为 2 年内的全因死亡率。在平均 16.5±8.2 个月的随访期间,有 117 人死亡(7.2%)。GHF 与死亡风险增加相关(风险比和 95%置信区间,1.97[1.15-3.37])。在考虑年龄、性别、平均心率、合并症和药物治疗后,包括时域、频域和样本熵在内的降低的 HRV 指数(比值比和 95%置信区间,0.79[0.70-0.89])均与 GHF 的存在独立相关。在亚组分析中,与老年人相比,HRV 降低在年轻人中更能预测 GHF。中介分析显示,HRV 和 GHF 之间存在显著的中介效应,除了对生存的各自不利影响外。
降低的 HRV 与 GHF 的存在独立相关。自主神经功能障碍可能参与了无先前心血管事件个体中 GHF 不良结局的发病机制。