The renal–cardiac connection in subjects with preserved ejection fraction: a population based study

Abstract

AimsChronic kidney disease (CKD) is prevalent and is associated with increased cardiovascular morbidity and mortality. The interaction between diastolic dysfunction (DD) and CKD in subjects with preserved systolic function is not well defined. This study sought to determine the association between renal function and DD in subjects with preserved ejection fraction.Methods and resultsThrough the Rochester Epidemiology Project, subjects who underwent echocardiography over 2 years with EF ≥50% were identified and the clinical data were obtained. Glomerular filtration rate (GFR) was estimated using the modification of diet in renal disease equation. Linear regression was used to test for association of GFR and DD. DD was defined as follows: Grade 2 or pseudonormal pattern (0.75 < E/A ≤ 1.5, E/e′ ≥ 10, DT > 140 ms, ΔE/A ≥ 0.5, and PV S < D) or Grade 3+ or restrictive pattern (E/A > 1.5, E/e′ ≥ 10, DT < 140 ms, and PV S < D). Cox regression was used to assess correlation of GFR and DD with time‐to‐event outcomes. A total of 2056 patients were identified. There was significant correlation between worsening GFR and degree of DD assessed by echo Doppler E/e′ ratio (P = 0.005), left ventricular mass index (P = 0.004), and right ventricular systolic pressure (P = 0.01). Worsening GFR was associated with increased mortality, development of heart failure, and hospitalization (P < 0.001). Within each GFR group, abnormal DD was associated with a higher risk of the clinical outcomes. No interaction between GFR and DD was noted, suggesting an increased risk of events associated with abnormal DD across ranges of GFR.ConclusionsWorsening GFR was associated with a greater degree of diastolic dysfunction and adverse clinical outcomes. Within each GFR group, the presence of DD was associated with increased morbidity and mortality. Further studies are warranted to determine if improving DD in patients with CKD will benefit clinical outcomes.

Predictors of acute kidney injury in patients undergoing adult cardiac surgery

“…It is already well known that this combined risk of undermanaged hypertension and diastolic dysfunction has independent effects on mortality. [ 15 ] More specifically there is now further clear evidence from other investigators of the deleterious effects of heart failure with preserved ejection fraction (HFpEF) on renal outcomes, both in the community[ 16 ] and after coronary artery bypass. [ 3 ]…”

Highlights in heart failure

“…101,102,188,189 The contribution of comorbidities to patients' outcomes may be similar in patients with HFrEF, compared with those with HFpEF, 189 or be larger in those with HFpEF according to other analyses. 132 The most frequent noncardiac comorbidities include chronic kidney disease, 21,32,134,[190][191][192][193] , chronic obstructive pulmonary disease, 194 central nervous system abnormalities, 195 sleep disordered breathing, 196,197 diabetes mellitus, 65,198,199 cancer, 188,200 and iron deficiency. 60,61,63,201 They were all shown to have a major impact on clinical presentation, response to treatment and outcomes.…”

Tetralogy of Fallot: Case-Based Update for the Treatment of Adult Congenital Patients

“…52 Diastolic dysfunction has been independently associated with ventricular arrhythmias and mortality in other disease states, such as post-coronary bypass surgery and chronic renal failure. 53 The value of LV diastolic dysfunction in risk stratification of patients with TOF remains to be demonstrated; however, the ratio of early transmitral flow velocity (E) to early diastolic mitral annular velocity (e'), more specifically, E/e ratio greater than 10 was a powerful predictor of ventricular arrhythmias. The association of diastolic dysfunction with increased RV afterload may contribute to the pathophysiology of RV failure, particularly in the setting of pulmonary regurgitation with chronic volume overload.…”