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首页> 外文期刊>Journal of cardiovascular electrophysiology >Risk factors for recurrent heart failure events in the Multicenter Automatic Defibrillator Implantation Trial II (MADIT-II).
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Risk factors for recurrent heart failure events in the Multicenter Automatic Defibrillator Implantation Trial II (MADIT-II).

机译：多中心自动除颤器植入试验II（MADIT-II）中复发性心力衰竭事件的危险因素。

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摘要

Risk Factors for Recurrent Heart Failure. BACKGROUND: This study was designed to identify risk factors for recurrent heart failure (HF) events in patients with ischemic left ventricular dysfunction enrolled in the Multicenter Automatic Defibrillator Implantation Trial II (MADIT-II). METHODS AND RESULTS: The Prentice, Williams, and Peterson (PWP) statistical model was utilized to identify and compare risk factors for 1 or >/= 2 HF hospitalizations among 1,218 patients with ischemic left ventricular dysfunction enrolled in the MADIT-II trial. Risk factors for a first HF hospitalization included treatment with an ICD (HR = 1.31; P = 0.05), New York Heart Association class > II (HR = 1.95; P < 0.001), female gender (HR = 1.38; P = 0.05), atrial fibrillation (HR = 1.90; P = 0.001), QRS >120 ms (HR = 1.41; P = 0.01), diabetes mellitus (HR = 1.51; P = 0.003), heart rate >/= 80 (HR = 1.35; P = 0.04), diuretic therapy (HR = 1.82; P < 0.001), and the presence of prerenal azotemia (defined as blood urea nitrogen:creatinine > 20; HR = 1.45; P = 0.01). In contrast, prerenal azotemia was the only risk factor that was independently associated with a significant increase in the risk of >/= 2 HF hospitalizations (HR = 1.52; P = 0.027). The occurrence of 1 HF event after enrollment was associated with a 2.8-fold (P < 0.001) increase in the risk of death, whereas after the occurrence of a second event there was a 6.7-fold (P < 0.001) increase in the risk of subsequent mortality. CONCLUSIONS: In MADIT-II, prerenal azotemia was the only significant and independent risk factor for HF progression after a first event, and recurrent HF was the most powerful predictor of mortality. These findings stress the importance of identifying risk factors for HF progression among patients who receive an ICD for primary prevention.
机译：复发性心力衰竭的危险因素。背景：本研究旨在确定参加多中心自动除颤器植入试验II（MADIT-II）的缺血性左心功能不全患者复发性心力衰竭（HF）事件的危险因素。方法和结果：MADIT-II试验采用Prentice，Williams和Peterson（PWP）统计模型来识别和比较1,218例缺血性左心功能不全患者中1例或≥/ = 2 HF住院的危险因素。首次HF住院的危险因素包括使用ICD治疗（HR = 1.31; P = 0.05），纽约心脏协会> II级（HR = 1.95; P <0.001），女性（HR = 1.38; P = 0.05） ，房颤（HR = 1.90; P = 0.001），QRS> 120 ms（HR = 1.41; P = 0.01），糖尿病（HR = 1.51; P = 0.003），心率> / = 80（HR = 1.35; P = 0.04），利尿剂治疗（HR = 1.82; P <0.001）和存在肾前氮质血症（定义为血液尿素氮：肌酐> 20; HR = 1.45; P = 0.01）。相反，肾前性氮质血症是唯一与> / = 2 HF住院风险显着增加相关的唯一危险因素（HR = 1.52; P = 0.027）。入选后发生1次HF事件与死亡风险增加2.8倍（P <0.001）相关，而第二次事件发生后，死亡风险增加6.7倍（P <0.001）后续死亡率。结论：在MADIT-II中，肾前氮质血症是首发事件后心衰进展的唯一重要且独立的危险因素，而复发性心衰是死亡率的最有力预测指标。这些发现强调了在接受ICD一级预防的患者中确定HF进展风险因素的重要性。

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