Pan Jiaqi, Zhang Enrui, Han Jie, Zou Haiyu, Zheng Liangrong
Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
Department of Cardiology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China.
Int J Cardiol Heart Vasc. 2024 Nov 16;55:101554. doi: 10.1016/j.ijcha.2024.101554. eCollection 2024 Dec.
Despite receiving pacemaker therapy, patients with heart failure with reduced ejection fraction (HFrEF) due to dilated cardiomyopathy (DCM) remain at an increased risk of adverse cardiovascular events. The high-sensitivity C-reactive protein (hs-CRP)-to-albumin ratio (CAR) is a novel indicator. This study aimed to assess the prognostic value of preoperative CAR in this population.
Patients with DCM who underwent cardiac resynchronization therapy (CRT) or implantable cardiac defibrillator (ICD) implantation for HFrEF between 2018 and 2023 were involved. The primary endpoint was major adverse cardiac events (MACE). Cox regression models were used to investigate predictors for MACE. Receiver operating characteristic (ROC) curve analysis was utilized to evaluate the diagnostic efficacy and identify the optimal cutoff point.
We enrolled 250 patients, of whom 78 experienced MACE. Patients who experienced MACE had a significantly higher CAR than those without MACE ( < 0.001). Multivariate Cox regression analysis indicated CAR as an independent predictor for MACE (hazard ratio = 4.301, 95 % confidence interval [CI] 1.833-10.091, < 0.001). ROC curve analysis demonstrated the discriminatory ability of CAR in predicting MACE (area under the curve [AUC] = 0.732, 95 % CI 0.666-0.792, < 0.001), with an optimal threshold of 0.08. Furthermore, the incidence of MACE was significantly higher in the high-CAR (> 0.08) group compared to the low-CAR (≤ 0.08) group (48.8 % vs. 13.6 %, < 0.001).
Among patients with DCM and HFrEF treated with CRT or ICD, CAR can serve as an independent risk predictor, with higher levels associated with poorer outcomes.
尽管接受了起搏器治疗，但因扩张型心肌病（DCM）导致射血分数降低的心力衰竭（HFrEF）患者发生不良心血管事件的风险仍然增加。高敏C反应蛋白（hs-CRP）与白蛋白比值（CAR）是一种新型指标。本研究旨在评估术前CAR在该人群中的预后价值。
纳入2018年至2023年间因HFrEF接受心脏再同步治疗（CRT）或植入式心脏除颤器（ICD）植入的DCM患者。主要终点是主要不良心脏事件（MACE）。采用Cox回归模型研究MACE的预测因素。利用受试者工作特征（ROC）曲线分析评估诊断效能并确定最佳截断点。
我们纳入了250例患者，其中78例发生了MACE。发生MACE的患者的CAR显著高于未发生MACE的患者（<0.001）。多变量Cox回归分析表明CAR是MACE的独立预测因素（风险比=4.301，95%置信区间[CI]1.833-10.091，<0.001）。ROC曲线分析显示CAR在预测MACE方面具有鉴别能力（曲线下面积[AUC]=0.732，95%CI 0.666-0.792，<0.001），最佳阈值为0.08。此外，高CAR（>0.08）组的MACE发生率显著高于低CAR（≤0.08）组（48.8%对13.6%，<0.001）。
在接受CRT或ICD治疗的DCM和HFrEF患者中，CAR可作为独立的风险预测指标，水平越高，预后越差。
