Martin Tapioca Fernanda Pinheiro, Santana Passos Luiz Carlos, Cafezeiro Caio, Carvalho Willian, Novis Rocha Paulo, Guimarães Maria Gabriela
Nephrology Department, Ana Nery Hospital, Salvador 40301-155, Brazil.
Medical School, Bahiana School of Medicine, Salvador 40110-060, Brazil.
J Clin Med. 2025 Jul 9;14(14):4862. doi: 10.3390/jcm14144862.
Impaired kidney function significantly increases mortality in recipients of implantable cardioverter defibrillators (ICDs). However, in the landmark studies evaluating ICDs and cardiac resynchronization therapy with a defibrillator (CRT-D) for the treatment of heart failure (HF) with a reduced ejection fraction (HFrEF), patients with Chagas cardiomyopathy (CC) have been underrepresented. This study aimed to determine whether kidney dysfunction has the same negative impacts on patients with ICDs or CRT-Ds and CC. : We prospectively followed patients with CC and left ventricular ejection fractions (LVEFs) of ≤40% who underwent ICD or CRT-D implantation and had at least one prior creatinine measurement. The primary outcome was the survival rate during follow-up. Variables with a of <0.10 from the univariate analysis were selected for inclusion in the Cox regression model. : A total of 343 patients were enrolled, with a median follow-up duration of 777 days. The mean age was 60.2 (±11.2) years. Fifty percent of patients were observed to have a New York Heart Association (NYHA) functional class of III, and the median left ventricular ejection fraction (LVEF) was 27% (22-32). Overall mortality events occurred in 113 (32.9%) participants during follow-up. Although the estimated glomerular filtration rate (eGFR) was significantly associated with survival in the univariate analysis [HR 0.98 (CI 95% 0.98-0.99), = 0.007], it did not retain significance in the multivariate model [HR 0.99 (0.98-1.00), = 0.138], which was adjusted for age, gender, atrial fibrillation (AF), body mass index (BMI), and the use of digoxin, furosemide, anticoagulants, and LVEF. : Unlike other cardiomyopathies, impaired eGFR was not an independent predictor of mortality in this cohort of CC patients undergoing ICD or CRT-D implantation, possibly due to the distinctive pathophysiological mechanisms of the disease. These findings suggest that clinicians should not be discouraged from recommending CIEDs in patients with CC and moderately impaired kidney function, although further studies are warranted to assess outcomes in those with advanced CKD.
肾功能受损会显著增加植入式心脏复律除颤器（ICD）接受者的死亡率。然而，在评估ICD和心脏再同步化治疗除颤器（CRT-D）用于治疗射血分数降低的心力衰竭（HFrEF）的里程碑式研究中，恰加斯心肌病（CC）患者的代表性不足。本研究旨在确定肾功能不全对ICD或CRT-D植入患者以及CC患者是否具有相同的负面影响。我们前瞻性地随访了接受ICD或CRT-D植入且左心室射血分数（LVEF）≤40%、至少有一次肌酐测量值的CC患者。主要结局是随访期间的生存率。单因素分析中P值<0.10的变量被选入Cox回归模型。总共纳入了343例患者，中位随访时间为777天。平均年龄为60.2（±11.2）岁。观察到50%的患者纽约心脏协会（NYHA）心功能分级为III级，左心室射血分数（LVEF）中位数为27%（22-32）。随访期间113例（32.9%）参与者发生了总体死亡事件。虽然在单因素分析中估计肾小球滤过率（eGFR）与生存率显著相关[风险比（HR）0.98（95%置信区间0.98-0.99），P = 0.007]，但在多变量模型中未保持显著性[HR 0.99（0.98-1.00），P = 0.138]，该模型对年龄、性别、心房颤动（AF）、体重指数（BMI）以及地高辛、呋塞米、抗凝剂的使用和LVEF进行了校正。与其他心肌病不同，eGFR受损在这组接受ICD或CRT-D植入的CC患者中并非死亡率的独立预测因素，这可能归因于该疾病独特的病理生理机制。这些发现表明，临床医生不应因肾功能中度受损而不愿为CC患者推荐植入式心脏电子设备（CIED），尽管有必要进一步研究以评估晚期慢性肾脏病患者的预后。
