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

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 as...

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Published in:The American heart journal 2014-04, Vol.167 (4), p.506-513
Main Authors: Ersbøll, Mads, MD, Valeur, Nana, MD, PhD, Hassager, Christian, MD, DSci, Søgaard, Peter, MD, DSci, Køber, Lars, MD, DSci
Format: Article
Language:English
Subjects:
Aged
Algorithms
Cardiovascular
Coronary vessels
Diabetes
Echocardiography, Doppler
Female
Follow-Up Studies
Glomerular Filtration Rate
Heart attacks
Heart Ventricles - diagnostic imaging
Heart Ventricles - physiopathology
Hospitalization
Humans
Hypertension
Male
Medical imaging
Middle Aged
Mortality
Myocardial Infarction - complications
Myocardial Infarction - diagnosis
Myocardial Infarction - physiopathology
Patients
Prognosis
Prospective Studies
Renal Insufficiency - etiology
Renal Insufficiency - physiopathology
Severity of Illness Index
Studies
Veins & arteries
Ventricular Function, Left - physiology
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cited_by cdi_FETCH-LOGICAL-c506t-fadf1c4f7ecee651059068c7e041ae90cfb76fa3fa37cbaafeabdef28502a7d43
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container_start_page 506
container_title The American heart journal
container_volume 167
creator Ersbøll, Mads, MD
Valeur, Nana, MD, PhD
Hassager, Christian, MD, DSci
Søgaard, Peter, MD, DSci
Køber, Lars, MD, DSci
description 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 1, multivessel disease and troponin. The prognostic impact of an eGFR
doi_str_mv 10.1016/j.ahj.2013.12.029
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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 &lt;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 &gt;1, multivessel disease and troponin. The prognostic impact of an eGFR &lt;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.</description><identifier>ISSN: 0002-8703</identifier><identifier>EISSN: 1097-6744</identifier><identifier>DOI: 10.1016/j.ahj.2013.12.029</identifier><identifier>PMID: 24655699</identifier><identifier>CODEN: AHJOA2</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Algorithms ; Cardiovascular ; Coronary vessels ; Diabetes ; Echocardiography, Doppler ; Female ; Follow-Up Studies ; Glomerular Filtration Rate ; Heart attacks ; Heart Ventricles - diagnostic imaging ; Heart Ventricles - physiopathology ; Hospitalization ; Humans ; Hypertension ; Male ; Medical imaging ; Middle Aged ; Mortality ; Myocardial Infarction - complications ; Myocardial Infarction - diagnosis ; Myocardial Infarction - physiopathology ; Patients ; Prognosis ; Prospective Studies ; Renal Insufficiency - etiology ; Renal Insufficiency - physiopathology ; Severity of Illness Index ; Studies ; Veins &amp; arteries ; Ventricular Function, Left - physiology</subject><ispartof>The American heart journal, 2014-04, Vol.167 (4), p.506-513</ispartof><rights>Mosby, Inc.</rights><rights>2014 Mosby, Inc.</rights><rights>Copyright © 2014 Mosby, Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Apr 2014</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c506t-fadf1c4f7ecee651059068c7e041ae90cfb76fa3fa37cbaafeabdef28502a7d43</citedby><cites>FETCH-LOGICAL-c506t-fadf1c4f7ecee651059068c7e041ae90cfb76fa3fa37cbaafeabdef28502a7d43</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24655699$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ersbøll, Mads, MD</creatorcontrib><creatorcontrib>Valeur, Nana, MD, PhD</creatorcontrib><creatorcontrib>Hassager, Christian, MD, DSci</creatorcontrib><creatorcontrib>Søgaard, Peter, MD, DSci</creatorcontrib><creatorcontrib>Køber, Lars, MD, DSci</creatorcontrib><title>The association between renal impairment and cardiac structure and function in patients with acute myocardial infarction</title><title>The American heart journal</title><addtitle>Am Heart J</addtitle><description>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 &lt;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 &gt;1, multivessel disease and troponin. The prognostic impact of an eGFR &lt;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. 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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 &lt;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 &gt;1, multivessel disease and troponin. The prognostic impact of an eGFR &lt;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.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>24655699</pmid><doi>10.1016/j.ahj.2013.12.029</doi><tpages>8</tpages></addata></record>
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subjects Aged
Algorithms
Cardiovascular
Coronary vessels
Diabetes
Echocardiography, Doppler
Female
Follow-Up Studies
Glomerular Filtration Rate
Heart attacks
Heart Ventricles - diagnostic imaging
Heart Ventricles - physiopathology
Hospitalization
Humans
Hypertension
Male
Medical imaging
Middle Aged
Mortality
Myocardial Infarction - complications
Myocardial Infarction - diagnosis
Myocardial Infarction - physiopathology
Patients
Prognosis
Prospective Studies
Renal Insufficiency - etiology
Renal Insufficiency - physiopathology
Severity of Illness Index
Studies
Veins & arteries
Ventricular Function, Left - physiology
title The association between renal impairment and cardiac structure and function in patients with acute myocardial infarction
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