Right ventricular dysfunction is associated with chronic kidney disease and predicts survival in patients with chronic systolic heart failure

被引:98
作者
Dini, Frank L. [1 ]
Demmer, Ryan T. [2 ]
Simioniuc, Anca [1 ]
Morrone, Doralisa [1 ]
Donati, Francesca [1 ]
Guarini, Giacinta [1 ]
Orsini, Enrico [1 ]
Caravelli, Paolo [1 ]
Marzilli, Mario [1 ]
Colombo, Paolo C. [3 ]
机构
[1] Univ Pisa, Cardiac Thorac & Vasc Dept, I-56124 Pisa, Italy
[2] Columbia Univ, Mailman Sch Publ Hlth, Dept Epidemiol, New York, NY 10027 USA
[3] Columbia Univ, Med Ctr, Coll Phys & Surg, Div Cardiol, New York, NY 10027 USA
基金
美国国家卫生研究院;
关键词
Congestion; Echocardiography; Glomerular filtration rate; Tricuspid annular plane systolic excursion; SOCIETY-OF-CARDIOLOGY; RENAL-FUNCTION; CARDIAC-OUTPUT; CARDIOVASCULAR-DISEASE; VENOUS CONGESTION; RISK-FACTORS; MORTALITY; PRESSURE; ECHOCARDIOGRAPHY; GUIDELINES;
D O I
10.1093/eurjhf/hfr176
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Chronic kidney disease (CKD) and right ventricular (RV) dysfunction are important predictors of prognosis in heart failure (HF). We investigated the relationship between RV dysfunction and CKD in outpatients with chronic systolic HF, an association which remains poorly defined. Outpatients (n 373) with chronic HF and left ventricular ejection fraction (LVEF) 45 underwent clinical and echo-Doppler evaluations and were followed up for 31 24 months. Tricuspid annular plane systolic excursion (TAPSE) assessed RV dysfunction. The estimated glomerular filtration rate (GFR) was measured by the simplified Modification of Diet in Renal Disease (MDRD) formula. Correlation analysis was used to characterize the association between TAPSE and estimated GFR. Odds ratios (ORs) for CKD and hazard ratios (HRs) for all-cause mortality were assessed using multivariable logistic or proportional hazards regression models. TAPSE and estimated GFR were significantly correlated (r 0.38, P 0.0001). TAPSE 14 mm was associated with elevated estimated right atrial pressure and N-terminal pro brain natriuretic peptide levels. TAPSE 14 mm increased the odds of estimated GFR 60 mL/min/1.73 m(2), OR [95 confidence interval (CI)] 2.51(1.444.39), P 0.0001 and predicted all-cause mortality, HR (95 CI) 1.80 (1.202.71) after multivariable adjustment. Right ventricular dysfunction is cross-sectionally associated with CKD and prospectively predicts survival in outpatients with chronic systolic HF. These data suggest RV dysfunction to be one of the possible mechanistic links between HF and CKD.
引用
收藏
页码:287 / 294
页数:8
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