Lombardi Gianmarco, Gambaro Alessia, Ferraro Pietro Manuel, De Tomi Elisa, Ribichini Flavio L, Gambaro Giovanni
Division of Nephrology, Department of Medicine, Azienda Ospedaliera Universitaria Integrata di Verona, University of Verona, Piazzale Aristide Stefani, 1, 37126, Verona, Italy.
Division of Cardiology, Department of Medicine, Azienda Ospedaliera Universitaria Integrata di Verona, University of Verona, Verona, Italy.
Clin Res Cardiol. 2024 Aug 27. doi: 10.1007/s00392-024-02531-1.
This study aimed to comprehensively analyze the relationship between serum potassium (K) levels and the risk of de novo cardiac arrhythmias in left ventricular assist device (LVAD) recipients.
We performed a retrospective study using the INTERMACS registry. Data was collected on adult patients with available K measurements taken 1-month post-LVAD implantation. K levels were the main exposure of interest and were analyzed as a continuous and categorical variable (quartiles of baseline K distribution). The main outcome of interest was the occurrence of de novo arrhythmia events, either sustained (ventricular [VA] or supraventricular arrhythmia [SVA]) or not sustained (atrial fibrillation/flutter [AF]). All-cause mortality was evaluated as the secondary outcome. Multivariable adjusted time-dependent Cox regression models and natural splines were used to describe the relationship between the exposure and outcomes of interest.
10,570 patients met our inclusion criteria. A significant and consistent relationship was observed between the lowest quartile of longitudinal K and the risk of arrhythmic events (HR 1.28, 95% CI 1.08, 1.53, p = 0.005) as well as in the highest K quartile (HR 1.24, 95% CI 1.02, 1.49, p = 0.027). A similar relationship was confirmed in the stratified analysis of arrhythmia types for SVAs and AF. The data were reflected in a U shaped relationship. Similarly, the highest and lowest quartiles of longitudinal K were independently associated with a significant increase in the HR of death, which was reflected by a U shaped relationship.
Our study reveals a significant U shaped relationship between low and high K + levels and cardiac arrhythmias in LVAD patients, particularly SVAs and AF. Both high and low K + levels negatively impacted patient survival.
本研究旨在全面分析左心室辅助装置（LVAD）接受者血清钾（K）水平与新发心律失常风险之间的关系。
我们使用INTERMACS注册中心进行了一项回顾性研究。收集了LVAD植入术后1个月有可用K测量值的成年患者的数据。K水平是主要的研究暴露因素，并作为连续变量和分类变量（基线K分布的四分位数）进行分析。主要的研究结局是新发心律失常事件的发生，包括持续性（室性[VA]或室上性心律失常[SVA]）或非持续性（心房颤动/扑动[AF]）。全因死亡率作为次要结局进行评估。使用多变量调整的时间依赖性Cox回归模型和自然样条来描述暴露因素与感兴趣结局之间的关系。
10570名患者符合我们的纳入标准。观察到纵向K的最低四分位数与心律失常事件风险之间存在显著且一致的关系（HR 1.28，95% CI 1.08，1.53，p = 0.005），在最高K四分位数中也是如此（HR 1.24，95% CI 1.02，1.49，p = 0.027）。在SVA和AF心律失常类型的分层分析中证实了类似的关系。数据反映为U形关系。同样，纵向K的最高和最低四分位数与死亡风险比的显著增加独立相关，这也由U形关系反映。
我们的研究揭示了LVAD患者低钾和高钾水平与心律失常之间存在显著的U形关系，尤其是SVA和AF。低钾和高钾水平均对患者生存产生负面影响。
