Renal implications of pulmonary arterial capacitance in acute heart failure with preserved ejection fraction

Abstract

This is an open access article under the CC BY-NC 4.0 license (https://creativecommons.org/licenses/by-nc/4.0/). Worsening renal function in patients with heart failure with preserved ejection fraction is associated with poor outcomes. Pulmonary arterial capacitance is a novel right heart catheterization derived hemodynamic metric representing pulmonary arterial tree distensibility and right ventricle afterload. Given the strong association between heart failure, pulmonary hypertension, and kidney function, the goal of this study is to investigate the correlation between Pulmonary arterial capacitance and long-term renal function in patients with heart failure with preserved ejection fraction. In this retrospective single center study, data from 951 patients with the diagnosis of heart failure, who underwent right heart catheterization were analyzed. Eight hundred and one patients with reduced ejection fraction, end-stage kidney disease on hemodialysis, acute myocardial infarction, and severe structural valvular disorders, were excluded. Pulmonary arterial capacitance was calculated as the stroke volume divided by pulmonary artery pulse pressure (mL/mmHg). Hemodynamic and clinical variables including baseline renal function were obtained at the time of the right heart catheterization, and renal function was also obtained at 3-5 years after right heart catheterization. The final cohort consisted of 150 subjects with a mean age 68 ( ± 14.2) years, 93 (62%) were female. The mean value for Pulmonary arterial capacitance was 2.82 ( ± 2.22) mL/mm Hg and the mean Glomerular Filtration Rate was 60.32 mL/min/l.73 m 2 ( ± 28.36). After multivariate linear regression analysis (including baseline Estimated Glomerular Filtration Rate as one of the variates), only age and Pulmonary arterial capacitance greater than 2.22 mL/mm Hg were predictors of long term Glomerular Filtration Rate. Pulmonary arterial capacitance as a novel right heart catheterization index could be a predictor of long-term renal function in patients with heart failure with preserved ejection fraction.

Renal Dysfunction Determinants in Advanced Heart Failure Patients: Pulmonary Artery Catheterization Study

“…They followed up 3-5 years merely PAC, and age was the predictor of the eGFR in the multivariable analysis. 11 In our study, we used the PAC-i had a linear positive relation with the eGFR. In HF patients, long duration sustained higher pulmonary artery pressures decreases the pulmonary artery distensibility, so the right ventricle has to generate more power to hurdle pulmonary artery afterload.…”

Prediction of Outcomes Through Cystatin C and cTnI in Elderly Type 2 Myocardial Infarction Patients

“… 33 Another possible mechanism is related to endothelial dysfunction, cardiac remodeling, vascular calcification, 34 neuro-hormonal activation, inflammatory cascade activation, 35 renal venous hypertension and elevated intra-abdominal pressures. 36 Furthermore, the poorer prognosis is possibly explained by more prevalent comorbidity, age, more frequent high-risk presentations of acute coronary syndrome, lower rates of complete revascularization, and underutilization of guideline-recommended therapies. A combination of these factors might explain the influence on adverse clinical outcomes.…”

Síndrome cardiorrenal: conceitos e impacto no estado de saúde – revisão integrativa / Cardiorrenal syndrome: concepts and impact on the state of health - integrative review

“…A alteração hemodinâmica da pressão arterial e pressão venosa central (PVC) estando ou não associada a baixo fluxo, hipotensão arterial e inflamação, são os determinantes mais importantes da síndrome cardiorrenal (77) . A fisiopatologia da SCR (5,12,27,32,33,47,48,51,52,58) abordada considera como importante fator de discussão, os desfechos clínicos relacionados às complicações, uma vez que a congestão venosa renal associa-se à falência de VD, diante da insuficiência tricúspide, do aumento da pressão intersticial renal e prejuízo da dinâmica renal, com consequente retenção de sal e agua, leva a hipervolemia (10) , comprometem de forma significativa a função renal, necessitando de terapia renal e muitas vezes levando a um pior prognóstico com aumento da mortalidade (18,21,30,38,44,50,55) .…”

“…A respeito disso, outros autores, descrevem que a dilatação e disfunção do VD, elevam a pressão venosa e prejudicam o enchimento do VE, reduzindo o DC, a pressão arterial e a central elevadas, resultam em congestão venosa que impacta diretamente na diminuição da função renal para pacientes com insuficiência cardíaca aguda (51 ) . O aumento da PVC, resulta em hipertensão venosa renal e consequente aumento da resistência renal, prejudicando o fluxo sanguíneo renal nos pacientes com falência cardíaca aguda.…”

“…O aumento da PVC, resulta em hipertensão venosa renal e consequente aumento da resistência renal, prejudicando o fluxo sanguíneo renal nos pacientes com falência cardíaca aguda. Estudo realizado por estes autores, mostrou que 75% dos pacientes que apresentaram PVC basal >24mmHg, desenvolveram piora da função renal (51) . A hiperuricemia identificada dos estudos (12,13,59) , foi identificada como fator de risco para SCR.…”