The association between renal impairment and cardiac structure and function in patients with acute myocardial infarction

TY - JOUR

T1 - The association between renal impairment and cardiac structure and function in patients with acute myocardial infarction

AU - Ersbøll, Mads

AU - Valeur, Nana

AU - Hassager, Christian

AU - Søgaard, Peter

AU - Køber, Lars

N1 - Copyright © 2014 Mosby, Inc. All rights reserved.

PY - 2014/4

Y1 - 2014/4

N2 - Background Renal dysfunction in patients with acute myocardial infarction (MI) is an important predictor of short- and long-term outcome. Cardiac abnormalities dominated by left ventricular (LV) hypertrophy are common in patients with chronic renal dysfunction. However, limited data exists on the association between LV systolic- and diastolic function assessed by comprehensive echocardiography and renal dysfunction in contemporary unselected patients with acute MI. Methods We prospectively included 1054 patients with acute MI (mean age 63 years, 73% male) and performed echocardiographic assessment of systolic and diastolic function within 48 hours of admission as well as estimated glomerular filtration rate (eGFR). Results Reduced eGFR was significantly associated with LV mass, LV ejection fraction, LV global strain (GLS) and E/e′ ratio. After multivariable adjustment, E/e′ ratio (P =.0096) remained the only echocardiographic measure independently associated with decreasing eGFR. During follow-up a total of 113 patients (10.7%) patients experienced the composite endpoint of all-cause mortality or hospitalization for heart failure. An eGFR <60 mL/min per 1.73 m2 was significantly associated with outcome (HR, 1.71; 95% CI, 1.12-2.62; P =.0131) after adjustment for age, diabetes, hypertension, Killip class >1, multivessel disease and troponin. The prognostic impact of an eGFR <60 mL/min per 1.73 m2 was only modestly altered by addition of LV mass or E/e′ ratio whereas addition of LV ejection fraction or GLS attenuated its importance considerably. Conclusion Renal dysfunction in patients with acute MI is independently associated with echocardiographic evidence of increased LV filling pressure. However, the prognostic importance of renal dysfunction is attenuated to a greater degree by LV longitudinal systolic function.

AB - Background Renal dysfunction in patients with acute myocardial infarction (MI) is an important predictor of short- and long-term outcome. Cardiac abnormalities dominated by left ventricular (LV) hypertrophy are common in patients with chronic renal dysfunction. However, limited data exists on the association between LV systolic- and diastolic function assessed by comprehensive echocardiography and renal dysfunction in contemporary unselected patients with acute MI. Methods We prospectively included 1054 patients with acute MI (mean age 63 years, 73% male) and performed echocardiographic assessment of systolic and diastolic function within 48 hours of admission as well as estimated glomerular filtration rate (eGFR). Results Reduced eGFR was significantly associated with LV mass, LV ejection fraction, LV global strain (GLS) and E/e′ ratio. After multivariable adjustment, E/e′ ratio (P =.0096) remained the only echocardiographic measure independently associated with decreasing eGFR. During follow-up a total of 113 patients (10.7%) patients experienced the composite endpoint of all-cause mortality or hospitalization for heart failure. An eGFR <60 mL/min per 1.73 m2 was significantly associated with outcome (HR, 1.71; 95% CI, 1.12-2.62; P =.0131) after adjustment for age, diabetes, hypertension, Killip class >1, multivessel disease and troponin. The prognostic impact of an eGFR <60 mL/min per 1.73 m2 was only modestly altered by addition of LV mass or E/e′ ratio whereas addition of LV ejection fraction or GLS attenuated its importance considerably. Conclusion Renal dysfunction in patients with acute MI is independently associated with echocardiographic evidence of increased LV filling pressure. However, the prognostic importance of renal dysfunction is attenuated to a greater degree by LV longitudinal systolic function.

KW - Aged

KW - Echocardiography, Doppler

KW - Female

KW - Follow-Up Studies

KW - Glomerular Filtration Rate

KW - Heart Ventricles

KW - Humans

KW - Male

KW - Middle Aged

KW - Myocardial Infarction

KW - Prognosis

KW - Prospective Studies

KW - Renal Insufficiency

KW - Severity of Illness Index

KW - Ventricular Function, Left

U2 - 10.1016/j.ahj.2013.12.029

DO - 10.1016/j.ahj.2013.12.029

M3 - Journal article

C2 - 24655699

SN - 0002-8703

VL - 167

SP - 506

EP - 513

JO - American Heart Journal

JF - American Heart Journal

IS - 4

ER -