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Echocardiographic and Hemodynamic Parameters Associated with Diminishing Renal Filtration among Patients with Heart Failure with Preserved Ejection Fraction
- Source :
- Cardiorenal Medicine. 9:83-91
- Publication Year :
- 2018
- Publisher :
- S. Karger AG, 2018.
-
Abstract
- Background: Renal dysfunction is an important predictor of poor outcomes in patients with heart failure with preserved ejection fraction (HFpEF). Right ventricular (RV) dysfunction is implicated as one of the explanations for worsening renal function in cardiorenal syndrome. Novel right heart catheterization (RHC) parameters such as pulmonary artery pulsatility index (PAPi) and right atrial to pulmonary capillary wedge pressure ratio (RA:PCWP) have been found as predictors of RV dysfunction. However, most studies investigating these parameters have been done in the setting of myocardial infarction or left ventricular assist device implantation, with limited data on these metrics in patients with HFpEF. Objective: The purpose of this study was to determine whether novel RHC parameters such as RA:PCWP and PAPi correlate with long-term renal outcomes among patients with HFpEF. Methods: A retrospective single-center study of adult patients with a documented diagnosis of heart failure who had RHC was performed between January 2006 and December 2010 at Einstein Med ical Center Philadelphia. Selected patients also had a serum B-type natriuretic peptide level ≥100 pg/mL and a PCWP ≥15 mm Hg. Patients with an ejection fraction < 50%, including those with recovered ejection fraction, and end-stage renal disease were excluded. Results: A total of 81 patients with a clinical diagnosis of HFpEF were identified who met the inclusion criteria. On multivariate analysis, after adjusting for age, sex, race, diabetes, hypertension, and cardiac index, PAPi was associated with long-term estimated glomerular filtration rate (eGFR) (β = 3.43, 95% CI = 0.635–6.23, p = 0.017), and RA:PCWP showed a trend towards significance (β = 14.81, 95% CI = –0.096–29.73, p = 0.051). The results were unchanged after further adjustment for eGFR at the time of RHC. Conclusion: Novel hemodynamic indices obtained by RHC may have predictive value for long-term renal dysfunction in patients with HFpEF.
- Subjects :
- Male
medicine.medical_specialty
Time Factors
Heart Ventricles
Urology
medicine.medical_treatment
030232 urology & nephrology
Cardiorenal syndrome
030204 cardiovascular system & hematology
Kidney
03 medical and health sciences
0302 clinical medicine
medicine.artery
Internal medicine
medicine
Humans
Renal Insufficiency
Myocardial infarction
Pulmonary wedge pressure
Retrospective Studies
Heart Failure
Ejection fraction
business.industry
Hemodynamics
Stroke Volume
Middle Aged
Prognosis
medicine.disease
Echocardiography
Ventricular assist device
Heart failure
Pulmonary artery
Ventricular Function, Right
Cardiology
Female
Cardiology and Cardiovascular Medicine
business
Heart failure with preserved ejection fraction
Follow-Up Studies
Glomerular Filtration Rate
Subjects
Details
- ISSN :
- 16645502 and 16643828
- Volume :
- 9
- Database :
- OpenAIRE
- Journal :
- Cardiorenal Medicine
- Accession number :
- edsair.doi.dedup.....943c3e1d66c4dd5bbba649218d08714e