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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

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

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.

KEYWORDS:

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

PMID:
24980489
PMCID:
PMC4810804
DOI:
10.1093/eurheartj/ehu254
[Indexed for MEDLINE]
Free PMC Article

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