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

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

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43 Scopus citations

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 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.

Original languageEnglish (US)
Pages (from-to)3442-3451
Number of pages10
JournalEuropean heart journal
Volume35
Issue number48
DOIs
StatePublished - Dec 21 2014

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Gori, M., Senni, M., Gupta, D. K., Charytan, D. M., Kraigher-Krainer, E., Pieske, B., Claggett, B., Shah, A. M., Santos, A. B. S., Zile, M. R., Voors, A. A., McMurray, J. J. V., Packer, M., Bransford, T., Lefkowitz, M., & Solomon, S. D. (2014). Association between renal function and cardiovascular structure and function in heart failure with preserved ejection fraction. European heart journal, 35(48), 3442-3451. https://doi.org/10.1093/eurheartj/ehu254