Association between renal function and cardiovascular structure and function in heart failure with preserved ejection fraction.

Abstract

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 m(2) 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.

• Authors: Mauro Gori, Michele Senni, Deepak K Gupta, David M Charytan, Elisabeth Kraigher-Krainer, Burkert Pieske, Brian Claggett, Amil M Shah, Angela B S Santos, Michael R Zile, Adriaan A Voors, John J V McMurray, Milton Packer, Toni Bransford, Martin Lefkowitz, Scott D Solomon, PARAMOUNT Investigators
• Journal: European heart journal (Eur Heart J) Vol. 35 Issue 48 Pg. 3442-51 (Dec 21 2014) ISSN: 1522-9645 [Electronic] England
• PMID: 24980489 (Publication Type: Clinical Trial, Phase II, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: [email protected].

Chemical References

• Creatinine

Topics

• Aged
• Albuminuria (pathology, physiopathology)
• Cardio-Renal Syndrome (pathology, physiopathology)
• Creatinine (urine)
• Echocardiography
• Female
• Glomerular Filtration Rate (physiology)
• Humans
• Hypertrophy, Left Ventricular (pathology, physiopathology)
• Male
• Prospective Studies
• Stroke Volume (physiology)