Department of Cardiology, Fujita Health University Bantane Hospital, Nagoya, Japan.
Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan.
ESC Heart Fail. 2024 Oct;11(5):3085-3094. doi: 10.1002/ehf2.14892. Epub 2024 Jun 10.
Sudden cardiac death (SCD) is a common mode of death in patients with congestive heart failure (CHF). Implantable cardioverter defibrillator (ICD) implantation is established treatment for SCD prevention, but current eligibility criteria based on left ventricular ejection fraction (LVEF) and New York Heart Association (NYHA) functional class may be due for reconsideration given the increasing effectiveness of pharmacological therapy. We sought to reconsider the risk stratification of SCD in patients with symptomatic CHF.
In total, 1,676 consecutive patients (74 ± 13 years old; 56% male) with NYHA class II or III CHF between 2008 and 2015 were enrolled for this prospective study. The endpoint was SCD.
During a median (interquartile range) follow-up period of 25 (4-70) months, 198 (11.8%) patients suffered SCD. Of those events, 23% occurred within 3 months of discharge. In the adjusted analyses, estimated glomerular filtration rate (eGFR) < 30 ml/min/1.73 m [hazard ratio (HR) 1.73, 95% confidence interval (CI) 1.11-2.70, P = 0.01] and LVEF ≤ 35% (HR 2.31, 95% CI 1.47-3.66, P < 0.01) were independent risk predictors of SCD. Addition of eGFR to LVEF significantly improved prediction of SCD in the C-index (P = 0.04), and in two metrics, net reclassification improvement (P = 0.01) and integrated discrimination improvement (P = 0.03). The predictive power of eGFR declined time-dependently over 2 years.
The addition of eGFR to current eligibility criteria may be useful for risk assessment of SCD, although its predictive power wanes over time. Roughly a quarter of the SCD occurred within 3 months after discharge in patients with CHF.
心力衰竭（CHF）患者的心脏性猝死（SCD）是常见的死亡模式。植入式心脏复律除颤器（ICD）的植入是预防 SCD 的既定治疗方法，但鉴于药物治疗的效果不断提高，目前基于左心室射血分数（LVEF）和纽约心脏协会（NYHA）功能分级的入选标准可能需要重新考虑。我们试图重新评估有症状 CHF 患者的 SCD 风险分层。
总共纳入了 2008 年至 2015 年间连续的 1676 例（74±13 岁；56%为男性）NYHA 心功能 II 或 III 级 CHF 患者，进行前瞻性研究。终点为 SCD。
在中位数（四分位间距）25（4-70）个月的随访期间，198 例（11.8%）患者发生 SCD。其中，23%的事件发生在出院后 3 个月内。在调整后的分析中，估计肾小球滤过率（eGFR）<30ml/min/1.73m [风险比（HR）1.73，95%置信区间（CI）1.11-2.70，P=0.01]和 LVEF≤35%（HR 2.31，95%CI 1.47-3.66，P<0.01）是 SCD 的独立危险因素。eGFR 的加入显著提高了 C 指数（P=0.04）中 SCD 的预测能力，在两个指标中，净重新分类改善（P=0.01）和综合鉴别力改善（P=0.03）。eGFR 的预测能力在 2 年内呈时间依赖性下降。
在当前的入选标准中加入 eGFR 可能有助于评估 SCD 风险，尽管其预测能力随时间推移而下降。大约四分之一的 CHF 患者在出院后 3 个月内发生 SCD。
