Data_Sheet_1_Estimated Glomerular Filtration Rate Is Associated With an Increased Risk of Death in Heart Failure Patients With Preserved Ejection Fraction.docx

Background: Renal dysfunction is associated with adverse cardiovascular outcomes in patients with heart failure (HF), but its impact on patients with heart failure with preserved ejection fraction (HFpEF) remains unclear.
Methods: 3,392 subjects of the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist) trial were assigned to two groups by estimated glomerular filtration rate (eGFR) ≥ 60 ml/min/1.73 m2 or 30–59 ml/min/1.73 m2. The outcomes, including all-cause death, cardiovascular death and HF hospitalization, were examined by multivariable cox models.
Results: Over a median follow-up of 3.4 ± 1.7 years, a total of 524 all-cause deaths, 334 cardiovascular deaths and 440 HF hospitalizations occurred. Compared with patients with eGFR ≥ 60 ml/min/1.73 m2, those with eGFR 30–59 ml/min/1.73 m2 were associated with an increased risk of the all-cause death [adjusted hazard ratio (HR), 1.47; 95% confidence interval (CI), 1.24–1.76; P < 0.001], cardiovascular death (adjusted HR, 1.53; 95% CI: 1.23–1.91; p < 0.001), and HF hospitalization (adjusted HR: 1.21; 95% CI: 1.00–1.47; p = 0.049) after multivariable adjustment for potential confounders.
Conclusions: eGFR 30–59 ml/min/1.73 m2 was related to an increased risk of all-cause death, cardiovascular death and HF hospitalization in HFpEF patients.

背景：肾功能不全与心力衰竭（HF）患者的不良心血管结局相关，但其对射血分数保留型心力衰竭（HFpEF）患者的影响尚不清楚。方法：本研究纳入醛固酮拮抗剂治疗射血分数保留型心力衰竭试验（TOPCAT）的3392名受试者，根据估算肾小球滤过率（eGFR）水平分为两组：eGFR≥60 ml/min/1.73㎡组与30~59 ml/min/1.73㎡组。采用多变量Cox模型分析全因死亡、心血管死亡及心衰住院等终点事件。结果：中位随访时长为3.4±1.7年，期间共发生524例全因死亡、334例心血管死亡及440例心衰住院事件。与eGFR≥60 ml/min/1.73㎡组患者相比，经潜在混杂因素多变量校正后，eGFR 30~59 ml/min/1.73㎡组患者的全因死亡风险显著升高[校正后风险比（HR）=1.47，95%置信区间（CI）：1.24~1.76，P<0.001]，心血管死亡风险亦显著升高（校正后HR=1.53，95%CI：1.23~1.91，P<0.001），心衰住院风险同样升高（校正后HR=1.21，95%CI：1.00~1.47，P=0.049）。结论：在HFpEF患者中，eGFR处于30~59 ml/min/1.73㎡水平与全因死亡、心血管死亡及心衰住院风险升高相关。