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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| Veröffentlicht in: | The American heart journal 2014-04, Vol.167 (4), p.506-513 |
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| 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 |
| format | Article |
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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 <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.</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 & 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>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1644775055?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995,64385,64387,64389,72469</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 <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.</description><subject>Aged</subject><subject>Algorithms</subject><subject>Cardiovascular</subject><subject>Coronary vessels</subject><subject>Diabetes</subject><subject>Echocardiography, Doppler</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Glomerular Filtration Rate</subject><subject>Heart attacks</subject><subject>Heart Ventricles - diagnostic imaging</subject><subject>Heart Ventricles - physiopathology</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Male</subject><subject>Medical imaging</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Myocardial Infarction - complications</subject><subject>Myocardial Infarction - diagnosis</subject><subject>Myocardial Infarction - physiopathology</subject><subject>Patients</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Renal Insufficiency - etiology</subject><subject>Renal Insufficiency - physiopathology</subject><subject>Severity of Illness Index</subject><subject>Studies</subject><subject>Veins & arteries</subject><subject>Ventricular Function, Left - physiology</subject><issn>0002-8703</issn><issn>1097-6744</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kl2L1DAYhYMo7rj6A7yRgDfetCZpmkwRBFn8ggUvXK_D2_QNk9qmY5K6zr83M7Mq7IUQyAfPOZBzXkKec1ZzxtXrsYbdWAvGm5qLmonuAdlw1ulKaSkfkg1jTFRbzZoL8iSlsVyV2KrH5EJI1baq6zbk180OKaS0WA_ZL4H2mG8RA40YYKJ-3oOPM4ZMIQzUQhw8WJpyXG1eI55e3RrsSesD3ReXQid66_OOgl0z0vmwnIXFLziIJ_gpeeRgSvjsbr8k3z68v7n6VF1_-fj56t11ZVumcuVgcNxKp9EiqpaztmNqazUyyQE7Zl2vlYOmLG17AIfQD-jEtmUC9CCbS_Lq7LuPy48VUzazTxanCQIuazK8eLJONFoU9OU9dFzWWGIolJJS65a1baH4mbJxSSmiM_voZ4gHw5k51mJGU2oxx1oMF6bUUjQv7pzXfsbhr-JPDwV4cwawRPHTYzTJlhwtDj6izWZY_H_t395T28kHb2H6jgdM_35hUhGYr8e5OI4Fl6dT0_wGYvu1VA</recordid><startdate>20140401</startdate><enddate>20140401</enddate><creator>Ersbøll, Mads, MD</creator><creator>Valeur, Nana, MD, PhD</creator><creator>Hassager, Christian, MD, DSci</creator><creator>Søgaard, Peter, MD, DSci</creator><creator>Køber, Lars, MD, DSci</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20140401</creationdate><title>The association between renal impairment and cardiac structure and function in patients with acute myocardial infarction</title><author>Ersbøll, Mads, MD ; Valeur, Nana, MD, PhD ; Hassager, Christian, MD, DSci ; Søgaard, Peter, MD, DSci ; Køber, Lars, MD, DSci</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c506t-fadf1c4f7ecee651059068c7e041ae90cfb76fa3fa37cbaafeabdef28502a7d43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Aged</topic><topic>Algorithms</topic><topic>Cardiovascular</topic><topic>Coronary vessels</topic><topic>Diabetes</topic><topic>Echocardiography, Doppler</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Glomerular Filtration Rate</topic><topic>Heart attacks</topic><topic>Heart Ventricles - diagnostic imaging</topic><topic>Heart Ventricles - physiopathology</topic><topic>Hospitalization</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Male</topic><topic>Medical imaging</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Myocardial Infarction - complications</topic><topic>Myocardial Infarction - diagnosis</topic><topic>Myocardial Infarction - physiopathology</topic><topic>Patients</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Renal Insufficiency - etiology</topic><topic>Renal Insufficiency - physiopathology</topic><topic>Severity of Illness Index</topic><topic>Studies</topic><topic>Veins & arteries</topic><topic>Ventricular Function, Left - physiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><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><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ersbøll, Mads, MD</au><au>Valeur, Nana, MD, PhD</au><au>Hassager, Christian, MD, DSci</au><au>Søgaard, Peter, MD, DSci</au><au>Køber, Lars, MD, DSci</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The association between renal impairment and cardiac structure and function in patients with acute myocardial infarction</atitle><jtitle>The American heart journal</jtitle><addtitle>Am Heart J</addtitle><date>2014-04-01</date><risdate>2014</risdate><volume>167</volume><issue>4</issue><spage>506</spage><epage>513</epage><pages>506-513</pages><issn>0002-8703</issn><eissn>1097-6744</eissn><coden>AHJOA2</coden><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 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.</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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