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

Am Heart J. 2014 Apr;167(4):506-13. doi: 10.1016/j.ahj.2013.12.029. Epub 2014 Jan 15.

Abstract

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 m(2) 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 m(2) 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.

MeSH terms

  • Aged
  • Echocardiography, Doppler
  • Female
  • Follow-Up Studies
  • Glomerular Filtration Rate
  • Heart Ventricles / diagnostic imaging
  • Heart Ventricles / physiopathology*
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / complications*
  • Myocardial Infarction / diagnosis
  • Myocardial Infarction / physiopathology
  • Prognosis
  • Prospective Studies
  • Renal Insufficiency / etiology*
  • Renal Insufficiency / physiopathology
  • Severity of Illness Index
  • Ventricular Function, Left / physiology*