Renal dysfunction, restrictive left ventricular filling pattern and mortality risk in patients admitted with heart failure: a 7-year follow-up study

BMC Nephrology

Lars Kober²  Jacob E Moller²  Dilek Akkan²  Finn Gustafsson²  Christian Hassager²  Christian Torp-Pedersen¹  Jesper Kjaergaard²  Morten Schou³ 

[1]Department of Cardiology, Gentofte University Hospital, DK-2600 Hellerup, Denmark

[2]Department of Cardiology, The Heart Centre and University of Copenhagen, Rigshospitalet, DK-2100 Copenhagen, Denmark

[3]Department of Cardiology and Endocrinology, Hillerod University Hospital, DK-3400 Hillerod, Denmark

关键词: Mortality risk;    Heart failure;    Restrictive filling pattern;    Estimated glomerular filtration rate;   

Others  :  1082772
DOI  :  10.1186/1471-2369-14-267

 received in 2012-09-17, accepted in 2013-11-26,  发布年份 2013

【 摘 要 】

Background

Renal dysfunction is associated with a variety of cardiac alterations including left ventricular (LV) hypertrophy, LV dilation, and reduction in systolic and diastolic function. It is common and associated with an increased mortality risk in heart failure (HF) patients. This study was designed to evaluate whether severe diastolic dysfunction contribute to the increased mortality risk observed in HF patients with renal dysfunction.

Methods

Using Cox Proportional Hazard Models on data (N = 669) from the EchoCardiography and Heart Outcome Study (ECHOS) study we evaluated whether estimated glomerular filtration rate (eGFR) was associated with mortality risk before and after adjustment for severe diastolic dysfunction. Severe diastolic dysfunction was defined by a restrictive left ventricular filling pattern (RF) (=deceleration time < 140 ms) by Doppler echocardiography.

Results

Median eGFR was 58 ml/min/1.73 m², left ventricular ejection fraction was 33% and RF was observed in 48%. During the 7 year follow up period 432 patients died. Multivariable adjusted eGFR was associated with similar mortality risk before (Hazard Ratio(HR)_{eGFR 10 ml increase}: 0.94 (95% CI: 0.89-0.99, P = 0.024) and after (HR_{eGFR 10 ml increase}: 0.93 (0.89-0.99), P = 0.012) adjustment for RF (HR: 1.57 (1.28-1.93), P < 0.001).

Conclusions

In patients admitted with HF RF does not contribute to the increased mortality risk observed in patients with a decreased eGFR. Factors other than severe diastolic dysfunction may explain the association between renal function and mortality risk in HF patients.

【 授权许可】

   
2013 Schou et al.; licensee BioMed Central Ltd.

【 图 表 】

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