Gori, M., Senni, M., Gupta, D. K, Charytan, D. M, Kraigher-Krainer, E., Pieske, B., Claggett, B. L, Shah, A. M, Santos, A. B, Zile, M. R, Voors, A. A, McMurray, J. J, Packer, M., Bransford, T., Lefkowitz, M. & Solomon, SD. (2014). Association between renal function and cardiovascular structure and function in heart failure with preserved ejection fraction. European Heart Journal,35(48), 3442-3451. United Kingdom: Oxford University Press. Retrieved from https://doi.org/10.1093/eurheartj/ehu254
Aim: Renal dysfunction is a common comorbidity in patients with heart failure and preserved ejection fraction (HFpEF). We sought to determine whether renal dysfunction was associated with measures of cardiovascular structure/function in patients with HFpEF. Methods: We studied 217 participants from the PARAMOUNT study with HFpEF who had echocardiography and measures of kidney function. We evaluated the relationships between renal dysfunction [estimated glomerular filtration rate (eGFR) > 30 and < 60 mL/min/1.73 m2 and/or albuminuria] and cardiovascular structure/function. Results: The mean age of the study population was 71 years, 55% were women, 94% hypertensive, and 40% diabetic. Impairment of at least one parameter of kidney function was present in 62% of patients (16% only albuminuria, 23% only low eGFR, 23% both). Renal dysfunction was associated with abnormal LV geometry (defined as concentric hypertrophy, or eccentric hypertrophy, or concentric remodelling) (adjusted P = 0.048), lower midwall fractional shortening (MWFS) (P = 0.009), and higher NT-proBNP (P = 0.006). Compared with patients without renal dysfunction, those with low eGFR and no albuminuria had a higher prevalence of abnormal LV geometry (P = 0.032) and lower MWFS (P < 0.01), as opposed to those with only albuminuria. Conversely, albuminuria alone was associated with greater LV dimensions (P < 0.05). Patients with combined renal impairment had mixed abnormalities (higher LV wall thicknesses, NT-proBNP; lower MWFS). Conclusion: Renal dysfunction, as determined by both eGFR and albuminuria, is highly prevalent in HFpEF, and associated with cardiac remodelling and subtle systolic dysfunction. The observed differences in cardiac structure/function between each type of renal damage suggest that both parameters of kidney function might play a distinct role in HFpEF.
Mary MacKillop Institute for Health Research
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