Association between renal function and cardiovascular structure and function in heart failure with preserved ejection fraction
Why the study?
Renal dysfunction is a common comorbidity in patients with HFpEF, but its association with cardiovascular structure and function was unclear.
Is renal dysfunction associated with abnormal cardiovascular structure and function in patients with HFpEF?
Population
217 participants with HFpEF from the PARAMOUNT study
Comparison
Patients with renal dysfunction vs patients without renal dysfunction
Design
Cross-sectional study with echocardiography and kidney function measures
Authors
Discussion
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Member takes
Implication
Renal dysfunction signals adverse remodeling in HFpEF; hypothesis-generating and requires prospective validation before clinical adoption.
Key Points
- To evaluate whether kidney dysfunction associates with specific alterations in cardiovascular structure and function among individuals diagnosed with heart failure with preserved ejection fraction.
- Evaluated 217 participants with HFpEF from the PARAMOUNT study who underwent echocardiography and laboratory kidney function assessments.
- Defined renal dysfunction as an estimated glomerular filtration rate (eGFR) between 30 and 60 mL/min/1.73 m² and/or the presence of albuminuria.
- Kidney impairment occurred in 62% of participants and significantly associated with abnormal left ventricular geometry (adjusted P = 0.048), lower midwall fractional shortening (P = 0.009), and higher NT-proBNP levels (P = 0.006).
- Compared to normal kidney function, isolated low eGFR was linked to abnormal LV geometry (P = 0.032) and lower MWFS (P < 0.01), whereas isolated albuminuria was associated with larger LV dimensions (P < 0.05).
- Combined low eGFR and albuminuria produced mixed cardiac defects, presenting with increased LV wall thickness, elevated NT-proBNP, and reduced MWFS.
Structured PICO
Is renal dysfunction associated with abnormal cardiovascular structure and function in patients with HFpEF?
P
Population
217 participants from the PARAMOUNT study with HFpEF who had echocardiography and measures of kidney function. Mean age 71 years, 55% women, 94% hypertensive, 40% diabetic.
C
Comparator
Patients without renal dysfunction
O
Outcome
Measures of cardiovascular structure and function (abnormal LV geometry, midwall fractional shortening, NT-proBNP)surrogate
In patients with HFpEF, renal dysfunction (both low eGFR and albuminuria) is highly prevalent and associated with distinct patterns of cardiac remodeling and subtle systolic dysfunction.
Cite This Study
Gori et al. (2014) studied this question.