The prognostic implications of renal insufficiency in asymptomatic and symptomatic patients with left ventricular systolic dysfunction
OBJECTIVES The present analysis examines the prognostic implications of moderate renal insufficiency in patients with asymptomatic and symptomatic left ventricular systolic dysfunction. BACKGROUND Chronic elevations in intracardiac filling pressures may lead to progressive ventricular dilation and h...
Gespeichert in:
| Veröffentlicht in: | Journal of the American College of Cardiology 2000-03, Vol.35 (3), p.681-689 |
|---|---|
| Hauptverfasser: | , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 689 |
|---|---|
| container_issue | 3 |
| container_start_page | 681 |
| container_title | Journal of the American College of Cardiology |
| container_volume | 35 |
| creator | Dries, Daniel L Exner, Derek V Domanski, Michael J Greenberg, Barry Stevenson, Lynne W |
| description | OBJECTIVES
The present analysis examines the prognostic implications of moderate renal insufficiency in patients with asymptomatic and symptomatic left ventricular systolic dysfunction.
BACKGROUND
Chronic elevations in intracardiac filling pressures may lead to progressive ventricular dilation and heart failure progression. The ability to maintain fluid balance and prevent increased intracardiac filling pressures is critically dependent on the adequacy of renal function.
METHODS
This is a retrospective analysis of the Studies of Left Ventricular Dysfunction (SOLVD) Trials, in which moderate renal insufficiency is defined as a baseline creatinine clearance |
| doi_str_mv | 10.1016/S0735-1097(99)00608-7 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_70954755</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0735109799006087</els_id><sourcerecordid>70954755</sourcerecordid><originalsourceid>FETCH-LOGICAL-c476t-8cc44a3ed4e7129a8bfa672238b52f6a5277eacc8b0ca8446e1dc943bf7193e83</originalsourceid><addsrcrecordid>eNqFkUGP1SAUhYnROG9Gf4KGhTG6qEILBVbGTBw1mcSF45pQenEwLVSgY94f8HdL33vR2bmBnOQ798I5CD2j5A0ltH_7lYiON5Qo8Uqp14T0RDbiAdpRzmXTcSUeot1f5Ayd5_yDVEpS9RidUSJozwTdod83t4CXFL-HmIu32M_L5K0pPoaMo8MJgpmwD3l1zlsPwe6rwibv56XE2WweE0Z8Xy_1hFAy_uXLLZ7AFXxXdfJ2nUyqaC6xLsHjPrs12G3XE_TImSnD09N9gb5dfbi5_NRcf_n4-fL9dWOZ6EsjrWXMdDAyELRVRg7O9KJtOznw1vWGt0KAsVYOxBrJWA90tIp1gxNUdSC7C_TyOLd--ecKuejZZwvTZALENWtBFGeC8wryI2hTzDmB00vys0l7TYneCtCHAvSWrlZKHwrQovqenxaswwzjPdcx8Qq8OAEmWzO5ZIL1-R_XSkXpNufdEYOaxp2HpPMhfRh9Alv0GP1_XvIHMcum9g</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>70954755</pqid></control><display><type>article</type><title>The prognostic implications of renal insufficiency in asymptomatic and symptomatic patients with left ventricular systolic dysfunction</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals Complete</source><source>Elektronische Zeitschriftenbibliothek - Freely accessible e-journals</source><source>Alma/SFX Local Collection</source><creator>Dries, Daniel L ; Exner, Derek V ; Domanski, Michael J ; Greenberg, Barry ; Stevenson, Lynne W</creator><creatorcontrib>Dries, Daniel L ; Exner, Derek V ; Domanski, Michael J ; Greenberg, Barry ; Stevenson, Lynne W</creatorcontrib><description>OBJECTIVES
The present analysis examines the prognostic implications of moderate renal insufficiency in patients with asymptomatic and symptomatic left ventricular systolic dysfunction.
BACKGROUND
Chronic elevations in intracardiac filling pressures may lead to progressive ventricular dilation and heart failure progression. The ability to maintain fluid balance and prevent increased intracardiac filling pressures is critically dependent on the adequacy of renal function.
METHODS
This is a retrospective analysis of the Studies of Left Ventricular Dysfunction (SOLVD) Trials, in which moderate renal insufficiency is defined as a baseline creatinine clearance <60 ml/min, as estimated from the Cockroft-Gault equation.
RESULTS
In the SOLVD Prevention Trial, multivariate analyses demonstrated moderate renal insufficiency to be associated with an increased risk for all-cause mortality (Relative Risk [RR] 1.41; p = 0.001), largely explained by an increased risk for pump-failure death (RR 1.68;p = 0.007) and the combined end point death or hospitalization for heart failure (RR 1.33; p = 0.001). Likewise, in the Treatment Trial, multivariate analyses demonstrated moderate renal insufficiency to be associated with an increased risk for all-cause mortality (RR 1.41;p = 0.001), also largely explained by an increased risk for pump-failure death (RR 1.49; p = 0.007) and the combined end point death or hospitalization for heart failure (RR 1.45; p = 0.001).
CONCLUSIONS
Even moderate degrees of renal insufficiency are independently associated with an increased risk for all-cause mortality in patients with heart failure, largely explained by an increased risk of heart failure progression. These data suggest that, rather than simply being a marker of the severity of underlying disease, the adequacy of renal function may be a primary determinant of compensation in patients with heart failure, and therapy capable of improving renal function may delay disease progression.</description><identifier>ISSN: 0735-1097</identifier><identifier>EISSN: 1558-3597</identifier><identifier>DOI: 10.1016/S0735-1097(99)00608-7</identifier><identifier>PMID: 10716471</identifier><identifier>CODEN: JACCDI</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Aged ; Angiotensin-Converting Enzyme Inhibitors - therapeutic use ; Biological and medical sciences ; Cardiology. Vascular system ; Cause of Death ; Creatinine - metabolism ; Disease Progression ; Enalapril - therapeutic use ; Female ; Heart ; Heart Failure - mortality ; Heart Failure - physiopathology ; Heart Failure - prevention & control ; Heart failure, cardiogenic pulmonary edema, cardiac enlargement ; Humans ; Male ; Medical sciences ; Middle Aged ; Prognosis ; Renal Insufficiency - etiology ; Renal Insufficiency - metabolism ; Risk Factors ; Stroke Volume ; Survival Rate ; Ventricular Dysfunction, Left - complications ; Ventricular Dysfunction, Left - drug therapy ; Ventricular Dysfunction, Left - physiopathology</subject><ispartof>Journal of the American College of Cardiology, 2000-03, Vol.35 (3), p.681-689</ispartof><rights>2000 American College of Cardiology</rights><rights>2000 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c476t-8cc44a3ed4e7129a8bfa672238b52f6a5277eacc8b0ca8446e1dc943bf7193e83</citedby><cites>FETCH-LOGICAL-c476t-8cc44a3ed4e7129a8bfa672238b52f6a5277eacc8b0ca8446e1dc943bf7193e83</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0735109799006087$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1289117$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/10716471$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Dries, Daniel L</creatorcontrib><creatorcontrib>Exner, Derek V</creatorcontrib><creatorcontrib>Domanski, Michael J</creatorcontrib><creatorcontrib>Greenberg, Barry</creatorcontrib><creatorcontrib>Stevenson, Lynne W</creatorcontrib><title>The prognostic implications of renal insufficiency in asymptomatic and symptomatic patients with left ventricular systolic dysfunction</title><title>Journal of the American College of Cardiology</title><addtitle>J Am Coll Cardiol</addtitle><description>OBJECTIVES
The present analysis examines the prognostic implications of moderate renal insufficiency in patients with asymptomatic and symptomatic left ventricular systolic dysfunction.
BACKGROUND
Chronic elevations in intracardiac filling pressures may lead to progressive ventricular dilation and heart failure progression. The ability to maintain fluid balance and prevent increased intracardiac filling pressures is critically dependent on the adequacy of renal function.
METHODS
This is a retrospective analysis of the Studies of Left Ventricular Dysfunction (SOLVD) Trials, in which moderate renal insufficiency is defined as a baseline creatinine clearance <60 ml/min, as estimated from the Cockroft-Gault equation.
RESULTS
In the SOLVD Prevention Trial, multivariate analyses demonstrated moderate renal insufficiency to be associated with an increased risk for all-cause mortality (Relative Risk [RR] 1.41; p = 0.001), largely explained by an increased risk for pump-failure death (RR 1.68;p = 0.007) and the combined end point death or hospitalization for heart failure (RR 1.33; p = 0.001). Likewise, in the Treatment Trial, multivariate analyses demonstrated moderate renal insufficiency to be associated with an increased risk for all-cause mortality (RR 1.41;p = 0.001), also largely explained by an increased risk for pump-failure death (RR 1.49; p = 0.007) and the combined end point death or hospitalization for heart failure (RR 1.45; p = 0.001).
CONCLUSIONS
Even moderate degrees of renal insufficiency are independently associated with an increased risk for all-cause mortality in patients with heart failure, largely explained by an increased risk of heart failure progression. These data suggest that, rather than simply being a marker of the severity of underlying disease, the adequacy of renal function may be a primary determinant of compensation in patients with heart failure, and therapy capable of improving renal function may delay disease progression.</description><subject>Aged</subject><subject>Angiotensin-Converting Enzyme Inhibitors - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>Cardiology. Vascular system</subject><subject>Cause of Death</subject><subject>Creatinine - metabolism</subject><subject>Disease Progression</subject><subject>Enalapril - therapeutic use</subject><subject>Female</subject><subject>Heart</subject><subject>Heart Failure - mortality</subject><subject>Heart Failure - physiopathology</subject><subject>Heart Failure - prevention & control</subject><subject>Heart failure, cardiogenic pulmonary edema, cardiac enlargement</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Prognosis</subject><subject>Renal Insufficiency - etiology</subject><subject>Renal Insufficiency - metabolism</subject><subject>Risk Factors</subject><subject>Stroke Volume</subject><subject>Survival Rate</subject><subject>Ventricular Dysfunction, Left - complications</subject><subject>Ventricular Dysfunction, Left - drug therapy</subject><subject>Ventricular Dysfunction, Left - physiopathology</subject><issn>0735-1097</issn><issn>1558-3597</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2000</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkUGP1SAUhYnROG9Gf4KGhTG6qEILBVbGTBw1mcSF45pQenEwLVSgY94f8HdL33vR2bmBnOQ798I5CD2j5A0ltH_7lYiON5Qo8Uqp14T0RDbiAdpRzmXTcSUeot1f5Ayd5_yDVEpS9RidUSJozwTdod83t4CXFL-HmIu32M_L5K0pPoaMo8MJgpmwD3l1zlsPwe6rwibv56XE2WweE0Z8Xy_1hFAy_uXLLZ7AFXxXdfJ2nUyqaC6xLsHjPrs12G3XE_TImSnD09N9gb5dfbi5_NRcf_n4-fL9dWOZ6EsjrWXMdDAyELRVRg7O9KJtOznw1vWGt0KAsVYOxBrJWA90tIp1gxNUdSC7C_TyOLd--ecKuejZZwvTZALENWtBFGeC8wryI2hTzDmB00vys0l7TYneCtCHAvSWrlZKHwrQovqenxaswwzjPdcx8Qq8OAEmWzO5ZIL1-R_XSkXpNufdEYOaxp2HpPMhfRh9Alv0GP1_XvIHMcum9g</recordid><startdate>20000301</startdate><enddate>20000301</enddate><creator>Dries, Daniel L</creator><creator>Exner, Derek V</creator><creator>Domanski, Michael J</creator><creator>Greenberg, Barry</creator><creator>Stevenson, Lynne W</creator><general>Elsevier Inc</general><general>Elsevier Science</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><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>7X8</scope></search><sort><creationdate>20000301</creationdate><title>The prognostic implications of renal insufficiency in asymptomatic and symptomatic patients with left ventricular systolic dysfunction</title><author>Dries, Daniel L ; Exner, Derek V ; Domanski, Michael J ; Greenberg, Barry ; Stevenson, Lynne W</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c476t-8cc44a3ed4e7129a8bfa672238b52f6a5277eacc8b0ca8446e1dc943bf7193e83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2000</creationdate><topic>Aged</topic><topic>Angiotensin-Converting Enzyme Inhibitors - therapeutic use</topic><topic>Biological and medical sciences</topic><topic>Cardiology. Vascular system</topic><topic>Cause of Death</topic><topic>Creatinine - metabolism</topic><topic>Disease Progression</topic><topic>Enalapril - therapeutic use</topic><topic>Female</topic><topic>Heart</topic><topic>Heart Failure - mortality</topic><topic>Heart Failure - physiopathology</topic><topic>Heart Failure - prevention & control</topic><topic>Heart failure, cardiogenic pulmonary edema, cardiac enlargement</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Prognosis</topic><topic>Renal Insufficiency - etiology</topic><topic>Renal Insufficiency - metabolism</topic><topic>Risk Factors</topic><topic>Stroke Volume</topic><topic>Survival Rate</topic><topic>Ventricular Dysfunction, Left - complications</topic><topic>Ventricular Dysfunction, Left - drug therapy</topic><topic>Ventricular Dysfunction, Left - physiopathology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Dries, Daniel L</creatorcontrib><creatorcontrib>Exner, Derek V</creatorcontrib><creatorcontrib>Domanski, Michael J</creatorcontrib><creatorcontrib>Greenberg, Barry</creatorcontrib><creatorcontrib>Stevenson, Lynne W</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American College of Cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Dries, Daniel L</au><au>Exner, Derek V</au><au>Domanski, Michael J</au><au>Greenberg, Barry</au><au>Stevenson, Lynne W</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The prognostic implications of renal insufficiency in asymptomatic and symptomatic patients with left ventricular systolic dysfunction</atitle><jtitle>Journal of the American College of Cardiology</jtitle><addtitle>J Am Coll Cardiol</addtitle><date>2000-03-01</date><risdate>2000</risdate><volume>35</volume><issue>3</issue><spage>681</spage><epage>689</epage><pages>681-689</pages><issn>0735-1097</issn><eissn>1558-3597</eissn><coden>JACCDI</coden><abstract>OBJECTIVES
The present analysis examines the prognostic implications of moderate renal insufficiency in patients with asymptomatic and symptomatic left ventricular systolic dysfunction.
BACKGROUND
Chronic elevations in intracardiac filling pressures may lead to progressive ventricular dilation and heart failure progression. The ability to maintain fluid balance and prevent increased intracardiac filling pressures is critically dependent on the adequacy of renal function.
METHODS
This is a retrospective analysis of the Studies of Left Ventricular Dysfunction (SOLVD) Trials, in which moderate renal insufficiency is defined as a baseline creatinine clearance <60 ml/min, as estimated from the Cockroft-Gault equation.
RESULTS
In the SOLVD Prevention Trial, multivariate analyses demonstrated moderate renal insufficiency to be associated with an increased risk for all-cause mortality (Relative Risk [RR] 1.41; p = 0.001), largely explained by an increased risk for pump-failure death (RR 1.68;p = 0.007) and the combined end point death or hospitalization for heart failure (RR 1.33; p = 0.001). Likewise, in the Treatment Trial, multivariate analyses demonstrated moderate renal insufficiency to be associated with an increased risk for all-cause mortality (RR 1.41;p = 0.001), also largely explained by an increased risk for pump-failure death (RR 1.49; p = 0.007) and the combined end point death or hospitalization for heart failure (RR 1.45; p = 0.001).
CONCLUSIONS
Even moderate degrees of renal insufficiency are independently associated with an increased risk for all-cause mortality in patients with heart failure, largely explained by an increased risk of heart failure progression. These data suggest that, rather than simply being a marker of the severity of underlying disease, the adequacy of renal function may be a primary determinant of compensation in patients with heart failure, and therapy capable of improving renal function may delay disease progression.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>10716471</pmid><doi>10.1016/S0735-1097(99)00608-7</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0735-1097 |
| ispartof | Journal of the American College of Cardiology, 2000-03, Vol.35 (3), p.681-689 |
| issn | 0735-1097 1558-3597 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_70954755 |
| source | MEDLINE; Elsevier ScienceDirect Journals Complete; Elektronische Zeitschriftenbibliothek - Freely accessible e-journals; Alma/SFX Local Collection |
| subjects | Aged Angiotensin-Converting Enzyme Inhibitors - therapeutic use Biological and medical sciences Cardiology. Vascular system Cause of Death Creatinine - metabolism Disease Progression Enalapril - therapeutic use Female Heart Heart Failure - mortality Heart Failure - physiopathology Heart Failure - prevention & control Heart failure, cardiogenic pulmonary edema, cardiac enlargement Humans Male Medical sciences Middle Aged Prognosis Renal Insufficiency - etiology Renal Insufficiency - metabolism Risk Factors Stroke Volume Survival Rate Ventricular Dysfunction, Left - complications Ventricular Dysfunction, Left - drug therapy Ventricular Dysfunction, Left - physiopathology |
| title | The prognostic implications of renal insufficiency in asymptomatic and symptomatic patients with left ventricular systolic dysfunction |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-14T13%3A14%3A38IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=The%20prognostic%20implications%20of%20renal%20insufficiency%20in%20asymptomatic%20and%20symptomatic%20patients%20with%20left%20ventricular%20systolic%20dysfunction&rft.jtitle=Journal%20of%20the%20American%20College%20of%20Cardiology&rft.au=Dries,%20Daniel%20L&rft.date=2000-03-01&rft.volume=35&rft.issue=3&rft.spage=681&rft.epage=689&rft.pages=681-689&rft.issn=0735-1097&rft.eissn=1558-3597&rft.coden=JACCDI&rft_id=info:doi/10.1016/S0735-1097(99)00608-7&rft_dat=%3Cproquest_cross%3E70954755%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=70954755&rft_id=info:pmid/10716471&rft_els_id=S0735109799006087&rfr_iscdi=true |