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Eur Heart J. 2014 Dec 21;35(48):3442-51. doi: 10.1093/eurheartj/ehu254. Epub 2014 Jun 30.

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

Author information

  • 1Division of Cardiovascular Medicine, Brigham and Women's Hospital, 75 Francis St, Boston 02445, MA, USA.
  • 2Cardiovascular Department, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy.
  • 3Renal Division and Clinical Biometrics, Brigham and Women's Hospital, Boston, MA, USA.
  • 4Medical University Graz, Graz, Austria.
  • 5Medical University of South Carolina, Charleston, SC, USA U.S. Department of Veterans Affairs, Ralph H. Johnson VA Medical Center, Charleston, SC, USA.
  • 6University of Groningen, Groningen, The Netherlands.
  • 7University of Glasgow, Glasgow, UK.
  • 8University of Texas Southwestern, Dallas, TX, USA.
  • 9Novartis Pharmaceuticals, East Hanover, NJ, USA.
  • 10Division of Cardiovascular Medicine, Brigham and Women's Hospital, 75 Francis St, Boston 02445, MA, USA ssolomon@rics.bwh.harvard.edu.



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.


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.


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).


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.

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.


Albuminuria; Cardiovascular structure and function; Chronic kidney disease; Glomerular filtration rate; Heart failure with preserved ejection fraction

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