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Renal dysfunction is a time-varying risk predictor of sudden cardiac death in heart failure
Yoshihiro Sobue1, Eiichi Watanabe1, Yusuke Funato2
1Department of Cardiology, Fujita Health University Bantane Hospital, Nagoya, Japan.
Insights
Sudden cardiac death risk in heart failure patients can be better predicted by adding estimated glomerular filtration rate (eGFR) to left ventricular ejection fraction (LVEF) criteria. This improves risk stratification for sudden cardiac death (SCD) in congestive heart failure (CHF) patients.
Area of Science:
- Cardiology
- Nephrology
- Public Health
Background:
- Sudden cardiac death (SCD) is a significant cause of mortality in patients with congestive heart failure (CHF).
- Current criteria for implantable cardioverter defibrillator (ICD) eligibility, primarily based on left ventricular ejection fraction (LVEF) and New York Heart Association (NYHA) functional class, may require reevaluation due to advancements in pharmacological therapies.
- Risk stratification for SCD in symptomatic CHF patients needs refinement.
Purpose of the Study:
- To re-evaluate and improve the risk stratification for sudden cardiac death (SCD) in patients diagnosed with symptomatic congestive heart failure (CHF).
- To investigate the predictive value of estimated glomerular filtration rate (eGFR) in conjunction with LVEF for SCD risk.
Main Methods:
- A prospective study involving 1,676 consecutive patients with NYHA class II or III CHF.
- Data collected between 2008 and 2015, with SCD as the primary endpoint.
- Statistical analyses included adjusted models to identify independent risk predictors and assess the incremental predictive value of eGFR.
Main Results:
- During a median follow-up of 25 months, 11.8% of patients experienced SCD.
- Independent predictors of SCD included eGFR < 30 ml/min/1.73 m² (HR 1.73) and LVEF ≤ 35% (HR 2.31).
- Adding eGFR to LVEF significantly improved SCD prediction, as indicated by C-index, net reclassification improvement, and integrated discrimination improvement.
Conclusions:
- Estimated glomerular filtration rate (eGFR) can enhance the current eligibility criteria for SCD risk assessment in CHF patients.
- The predictive power of eGFR for SCD diminishes over time, showing a time-dependent decline over 2 years.
- A notable proportion (23%) of SCD events occurred within 3 months post-discharge, highlighting a critical period for monitoring.
Aims:
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.
Methods:
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.
Results:
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 m2 [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.
Conclusions:
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.
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