Background -Severe renal dysfunction is associated with a worse outcome after coronary artery bypass graft surgery(CABG). Less is known about the effects of milder degrees of renal impairment, and previous studies hav...Background -Severe renal dysfunction is associated with a worse outcome after coronary artery bypass graft surgery(CABG). Less is known about the effects of milder degrees of renal impairment, and previous studies have relied on levels of serum creatinine, an insensitive indicator of renal function. Recent studies have suggested that estimated glomerular filtration rate(eGFR) is a more discriminatory measure. However, data on the utility of eGFR in predicting outcome from CABG are limited. Methods and Results -We studied 2067 consecutive patients undergoing CABG. Demographic and clinical data were collected preoperatively, and patients were followed up a median of 2.3 years after surgery. Estimated GFR was calculated from the Modification of Diet in Renal Disease equation. The primary outcome was all-cause mortality. Mean±SD eGFR was 57.9±17.6 mL/min per 1.73 m2 in the 158 patients who died during follow-up compared with 64.7±13.8 mL/min per 1.73m2 in survivors(hazard ratio[HR], 0.71 per 10 mL/min per 1.73 m2; 95%CI, 0.64 to 0.80; P< 0.001). Estimated GFR was an independent predictor of mortality in both models with other individual univariable predictors(HR, 0.80 per 10 mL/min per 1.73 m2; 95%CI, 0.72 to 0.89; P< 0.001) and the European system for cardiac operative risk evaluation(HR, 0.88 per 10 mL/min per 1.73 m2; 95%CI, 0.78 to 0.98; P=0.02). Conclusions -Estimated GFR is a powerful and independent predictor of mortality after CABG.展开更多
This study assessed the relation between B-type natriuretic peptide(BNP) and echocardiographic indexes of left ventricular(LV) filling pressure in 53 patients with stable heart failure and without significant valvular...This study assessed the relation between B-type natriuretic peptide(BNP) and echocardiographic indexes of left ventricular(LV) filling pressure in 53 patients with stable heart failure and without significant valvular dysfunction. Left atrial volume indexed to body surface area(LAVi), an indicator of chronic LV filling pressure, was correlated with BNP(r=0.692, p< 0.001) and was the strongest independent predictor of elevated levels in this cohort. LAVi was also the best predictor of BNP ≥100 pg/ml, with an area under the receiver-operating characteristic curve of 0.85(95%confidence interval 0.74 to 0.96, p< 0.001). Using the optimal cutoff of >31 ml/m2, LAVi had a sensitivity of 92%and a specificity of 65%for BNP ≥100 pg/ml. Patients with LAVi >31 ml/m2 had a median BNP of 122 pg/ml, compared with 21 pg/ml in patients with LAVi ≤31 ml/m2(p< 0.001). These findings suggest that in patients with stable heart failure, BNP levels are related to chronic LV filling pressures. This may help explain the relatively modest correlation between BNP and acute measures of LV filling and the heterogeneity in BNP levels in patients with stable heart failure.展开更多
文摘Background -Severe renal dysfunction is associated with a worse outcome after coronary artery bypass graft surgery(CABG). Less is known about the effects of milder degrees of renal impairment, and previous studies have relied on levels of serum creatinine, an insensitive indicator of renal function. Recent studies have suggested that estimated glomerular filtration rate(eGFR) is a more discriminatory measure. However, data on the utility of eGFR in predicting outcome from CABG are limited. Methods and Results -We studied 2067 consecutive patients undergoing CABG. Demographic and clinical data were collected preoperatively, and patients were followed up a median of 2.3 years after surgery. Estimated GFR was calculated from the Modification of Diet in Renal Disease equation. The primary outcome was all-cause mortality. Mean±SD eGFR was 57.9±17.6 mL/min per 1.73 m2 in the 158 patients who died during follow-up compared with 64.7±13.8 mL/min per 1.73m2 in survivors(hazard ratio[HR], 0.71 per 10 mL/min per 1.73 m2; 95%CI, 0.64 to 0.80; P< 0.001). Estimated GFR was an independent predictor of mortality in both models with other individual univariable predictors(HR, 0.80 per 10 mL/min per 1.73 m2; 95%CI, 0.72 to 0.89; P< 0.001) and the European system for cardiac operative risk evaluation(HR, 0.88 per 10 mL/min per 1.73 m2; 95%CI, 0.78 to 0.98; P=0.02). Conclusions -Estimated GFR is a powerful and independent predictor of mortality after CABG.
文摘This study assessed the relation between B-type natriuretic peptide(BNP) and echocardiographic indexes of left ventricular(LV) filling pressure in 53 patients with stable heart failure and without significant valvular dysfunction. Left atrial volume indexed to body surface area(LAVi), an indicator of chronic LV filling pressure, was correlated with BNP(r=0.692, p< 0.001) and was the strongest independent predictor of elevated levels in this cohort. LAVi was also the best predictor of BNP ≥100 pg/ml, with an area under the receiver-operating characteristic curve of 0.85(95%confidence interval 0.74 to 0.96, p< 0.001). Using the optimal cutoff of >31 ml/m2, LAVi had a sensitivity of 92%and a specificity of 65%for BNP ≥100 pg/ml. Patients with LAVi >31 ml/m2 had a median BNP of 122 pg/ml, compared with 21 pg/ml in patients with LAVi ≤31 ml/m2(p< 0.001). These findings suggest that in patients with stable heart failure, BNP levels are related to chronic LV filling pressures. This may help explain the relatively modest correlation between BNP and acute measures of LV filling and the heterogeneity in BNP levels in patients with stable heart failure.
