Key result
Mild renal dysfunction linked to ~100% greater SCD risk in ischemic LV dysfunction.
Why the study?
It is unclear if the risk and risk factors of sudden cardiac death in patients with ischemic left ventricular dysfunction are modulated by mild chronic renal insufficiency.
Does mild renal dysfunction increase the risk of sudden cardiac death and all-cause mortality in patients with ischemic left ventricular dysfunction?
Cohort
Yes
Does mild renal dysfunction increase the risk of sudden cardiac death and all-cause mortality in patients with ischemic left ventricular dysfunction?
Mild renal dysfunction significantly increases the risk of sudden cardiac death and all-cause mortality in patients with ischemic left ventricular dysfunction, and beta-blocker therapy may reduce this arrhythmic risk.
Answers are grounded in this paper and cite their sources.
May warrant closer SCD monitoring in mild CKD with ischemic LV dysfunction; leaves open whether targeted interventions improve outcomes.
BACKGROUND: Patients with ischemic left ventricular dysfunction have a high risk of sudden cardiac death (SCD). It is, however, unclear if the risk and risk factors of SCD in these patients is modulated by the coexistence of mild chronic renal insufficiency. METHODS: We performed a post-hoc analysis of the outcome associated with mild renal dysfunction, as defined by an estimated glomerular filtration rate (eGFR) of <75 ml/min/1.73 m2 in patients allocated to the conventional medical therapy arm of the Multicenter Automatic Defibrillator Implantation Trial-II. RESULTS: In multivariable analysis, renal dysfunction was independently associated with significant increased risks for all-cause mortality (hazard ratio [HR] = 1.86; 95% CI 1.13-3.05) and SCD (HR = 2.00; 95% CI 1.01-4.02), but not non-SCD, compared to patients without renal dysfunction. Independent predictors of SCD in patients with renal dysfunction were: increased resting heart rate (HR = 2.40; 95% CI 1.50-3.86); low diastolic blood pressure (HR = 3.23; 95% CI 1.52-6.66), and a prolonged QRS duration (HR = 1.63; 95% CI 1.02-2.61). Beta-blocker therapy was independently associated with a significant reduction in the risk of SCD in patients with an eGFR of <75 ml/min/1.73 m2 (HR = 0.61; 95% CI 0.38-0.99). CONCLUSION: These findings suggest that renal dysfunction significantly increases the risk for SCD in patients with left ventricular dysfunction, and that beta-blocker therapy reduces the risk of arrhythmic mortality in heart failure patients with coexisting renal insufficiency.
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Chonchol et al. (2007) conducted a cohort in Ischemic left ventricular dysfunction. Mild renal dysfunction (eGFR <75 ml/min/1.73 m2) vs. Patients without renal dysfunction was evaluated on Sudden cardiac death (HR 2.00, 95% CI 1.01-4.02). Mild renal dysfunction was independently associated with a significantly increased risk of sudden cardiac death (HR 2.00; 95% CI 1.01-4.02) in patients with ischemic left ventricular dysfunction.
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